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NAMED FRACTURES OF FOREARM ,WRIST & HAND
Dr. Jim Jacob Roy (House Surgeon , Ortho 3 Unit )
NAMED FRACTURES OF FOREARM ,
WRIST & HAND • Monteggia fracture dislocation• Galeazzi fracture dislocation• Colles’ fracture • Smith’s fracture• Barton’s fracture • Chauffer’s fracture• Bennett’s fracture • Rolando’s fracture • Boxer’s fracture
MONTEGGIA FRACTURE DISLOCATION
• This fracture is named after Giovanni Battista Monteggia ,an Italian surgeon.
MONTEGGIA FRACTURE DISLOCATION
• A fracture of the proximal third of ulna with dislocation of the head of the radius .
• MOI - Fall on an outstretched hand - Direct blow on the back of upper forearm
Classification system – Bado classification ( 4 types )
• 2 major types – Extension type & Flexion type
• TREATMENT Closed Manual Reduction & AE Slab
Application ( Monitor closely by weekly Check X rays because there is high chance of redisplacement)
Open Reduction & Internal Fixation using a plate
COMPLICATIONS
• Malunion (especially if treated conservatively) • Deformity & limitation of forearm
movements)
GALEAZZI FRACTURE DISLOCATION
• Named after Ricardio Galeazzi ,an Italian Orthopaedician .
• A fracture of the distal third of radius with dislocation or subluxation of the distal radio ulnar joint .
• MOI - Fall on an outstretched hand
• A FRACTURE OF NECESSITY
• TREATMENT
Closed Manual Reduction ( difficult to attain & maintain except in children)
Open Reduction & Internal Fixation with a plate
COMPLICATIONS
• Malunion • Deformity & limitation of supination &
pronation
COLLES’ FRACTURE • Named after Abraham
Colles , Professor of Anatomy, Surgery and Physiology at the Royal College of Surgeons in Ireland .
COLLES’ FRACTURE • A fracture at the distal end of the radius , at its
cortico cancellous junction with typical displacement .
• Commonest fracture in adults above 40 years of age .
• Common in women because of postmenopausal osteoporosis
• MOI - Fall on an outstretched hand
• Displacements –
Impaction of fragments Dorsal displacement Dorsal tilt Lateral displacement Lateral tilt Supination
• COMMON ASSOCIATED INJURIES
• Fracture of the styloid process of ulna • Rupture of the ulnar collateral ligament • Rupture of the triangular cartilage of the ulna • Rupture of the interosseous radio ulnar
ligament , causing radio ulnar subluxation
• Classical Deformity : “ Dinner Fork Deformity “
• TREATMENT
• If Undisplaced - Immobilisation in a BE Plaster Slab / Cast .
• If Displaced - CMR , followed by immobilisation in Colles’ cast .
• CMR - Relaxation of the forearm muscles Disimpaction of the fragments Correction of the displacement Plaster application
• Check X ray
• Encourage active finger movements & elbow & shoulder movements through their full range
• In Young Individuals ,
o Percutaneous Transfixation using K wires
o External fixator
o Fixation using LCP
• COMPLICATIONS
Stiffness of joints (Finger stiffness is the commonest complication)
Malunion ( Correct malunion by osteotomy if there is an ugly deformity / if it hampers the day to day activities of the individual)
Subluxation of the IRUJ – painful & restriction of wrist movements ( Excision of the lower end of ulna – Darrach’s resection – in selected cases)
Carpal Tunnel Syndrome ( median nerve is compressed in the carpal tunnel by the encroaching fracture callus)
Sudeck’s osteodystrophy – Colles’ fracture being the commonest cause of Sudeck’s osteodystrophy in upper limb ( Intensive Physiotherapy is required )
Rupture of EPL - either due to loss of blood supply to the tendon at the time of injury or due to friction on th tendon during its movements over the malunited fracture ( needs tendon transfer)
SMITH’S FRACTURE• Named after Robert William Smith ,an Irish
surgeon .• Reverse of Colles’ fracture
• Uncommon
• Distal fragment displaces ventrally & tilts ventrally
• TREATMENT – CMR & plaster immobilsation for 6 weeks
BARTON’S FRACTURE • Named after John Rhea Barton ,an American
surgeon.
• An intra articular fracture of the distal end of radius – the fracture extends from the radius to either its anterior or posterior cortices .
• 2 types – Volar & Dorsal ( depending on the displacement of the distal fragment)
• TREATMENT
• Closed Manual Reduction & Plaster immobilisation
• Open reduction & internal fixation with a plate ( if CMR fails & as a primary choice in young adults with significantly displaced fractures)
CHAUFFER’S FRACTURE( Backfire fracture / Hutchison fracture)
• A fracture of the radial styloid process
• The name originates from early chauffeurs who sustained these injuries when the car back-fired while the chauffeur was hand-cranking to start the car.
• The back-fire forced the crank backward into the chauffeur's palm and produced the characteristic styloid fracture.
BENNETT’S FRACTURE DISLOCATION
• Named after Edward Hallaran Bennett , Professor of Surgery at Trinity College of the University of Dublin .
• an An oblique intra articular fracture of the base of the 1st metacarpal with subluxation or dislocation of the metacarpal .
TREATMENT -
• Closed reduction & percutaneous K wire fixation with the help of an image intensifier .
• Open reduction & internal fixaion with a K wire .
• COMPLICATIONS
• Osteoarthritis of the joint – persistent pain & loss of grip ( excision of trapezium in painful arthritis)
ROLANDO’S FRACTURE • Named after Silvio
Rolando .
• A complete articular , T or Y shaped fracture of the 1st metacarpal .
• TREATMENT – Reduction & fixation with K wire & immobilsation in a thumb spica for 3 weeks
BOXER'S FRACTURE • a colloquial term for
a fracture of one of the metacarpal bones of the hand.
• Classically, the fracture occurs transversely across the neck of the bone, after the patient strikes an object with a closed fist.
SUMMARY• Monteggia fracture dislocation
• Galeazzi fracture dislocation• Colles’ fracture • Smith’s fracture
• Barton’s fracture • Bennett’s fracture • Rolando’s fracture
INTRA ARTICULAR FRACTURES
FRACTURES OF RADIUS
FRACTURE OF ULNA