B11. Forearm fractures. Distal radius fractures.

Forearm fractures

Forearm fractures have the second highest ratio of open to closed fractures among all fractures. They’re also common in children.

We distinguish simple forearm fractures from complex ones. Simple fractures are isolated fractures of the radius or ulna (sometimes called nightstick fracture). Complex fractures are fractures occurring with dislocations. The three most important complex fractures are:

Name	Fracture location	Dislocation location
Galeazzi	Distal radius	Radioulnar joint
Monteggia	Proximal ulna	Radial head
Essex-Lopresti	Radial head	Radioulnar joint (+ interosseus disruption)

These injuries occur due to direct trauma or fall onto outstretched arm. As the forearm is basically a joint, the goal should be anatomical reduction and absolute stability. Treatment is surgical.

Etiology

Direct trauma to forearm, fall from height onto outstretched and pronated forearm, high energy trauma.

Clinical features

Deformity, pain, swelling, loss of function. Neurovascular injuries. Compartment syndrome.

Diagnosis and evaluation

X-ray is usually sufficient. In case of Essex-Lopresti injury there is radio-ulnar dissociation.

Treatment

The forearm is basically a joint, and so the goal of management (as for all joints) should be anatomical reduction and absolute stability. Treatment is almost always surgical with ORIF or OREF.

Distal radius fractures

Distal radius fractures are common fractures, especially of the elderly. They occur due to fall on outstretched arm. Colles fracture is an extraarticular fracture with dorsal angulation of the fragment. Smith fracture is an extraarticular fracture with ventral angulation of the fragment. The median nerve may be injured. Non-dislocated fractures are treated conservatively; dislocated fractures are treated surgically.

Etiology

Fall on outstretched arm with dorsiflexed wrist (Colles fracture) or palmar flexed wrist (Smith facture).

Classification

We distinguish multiple type of distal radius fractures:

Type	Description
Colles fracture	Extraarticular fracture with dorsal angulation of the fragment
Smith fracture	Extraarticular fracture with ventral angulation of the fragment
Barton fracture	Intraarticular with associated dorsal displacement (radiocarpal dislocation)
Chauffeur fracture	Avulsion fracture of radial styloid

Clinical features

Pain, swelling, deformation, displacement. Median nerve injury. Carpal tunnel syndrome.

Diagnosis and evaluation

X-ray.

Treatment

Conservative treatment with closed reduction + splint is used for fractures without dislocation or with minimal dislocation.

Surgical treatment with ORIF is used for dislocated fractures.