FRACTURE BOTH BONES OF THE FOREARM
|BONES OF THE FOREARM|
Mechanism of Injury
Fracture both bones of forearm in adults are frequently thanks to RTA, falls, assault, etc. this is often a difficult problem especially in adults. The fracture might be thanks to either direct or indirect trauma.
The patient presents with severe pain, swelling and deformity of the forearm. Movements of the forearm are severely restricted and every one other features of fractures are usually present.
The AP, lateral and oblique views of the forearm help to form an accurate diagnosis.
Conservative treatment: Undisplaced, incomplete fractures are treated by immoblilization with an above elbow plaster slab or cast. The treatment for displaced fractures consists of closed reduction by traction and counter traction methods under general anaesthesia followed by an above elbow cast , is typically successful in children.
Surgery: In adults open reduction internal fixation (ORIF) is usually indicated because it’s difficult to regain length, apposition, axial and normal rotational alignment in adults by closed reduction.The Open reduction is by two approaches, one for the radius and therefore the other for the ulna.The choice of implants for ulna is either a medullary nail or the plate and screws except for fracture radius, rigid compression plating is typically desired and Cancellous bone grafting is completed if the comminution is quite one-third of the circumference of the bone.
The choice of plate osteosynthesis are:
• Dynamic compression plates are still popular.
• Low contact: Dynamic compression plates have the advantage of less periosteal vascular damage.
• DCP plates with preliminary K-wire fixation helps in holding the fracture reduction while the ultimate screws are fixed.
• Low contact: Locking dynamic compression plates helps to get both rigid fixation and fewer vascular damage.
• Locked compression plating is that the preferred method lately .
Intramedullary fixation: IM nail fixation of both bones fractures with K-wires, Rush nails, etc. was popular within the 1950’s and was gradually replaced by plates thanks to the less rigid fixation it offered.Now they’re returning with a bang because of the innovations within the nails technology just like the advent of intramedullary interlocking nailing and is being mainly utilized in the pediatric group than adults.
• Segmental fracture.
• compound fracture with soft tissues injury and/or bone loss.
• Multiple injuries.
• Failed plating.
• Pathological fractures.
• Less exposure.
• Less periosteal stripping.
• Bone grafting isn’t required.
Choices of IM Nails
• Non reamed interference fit, prebent star shaped titanium ulnar and radial nails.
• chrome steel straight distal locking nail system.
• Interlocking nails with the both proximal and distal locking.
Complications of Fracture Both Bones of Forearm
Volkmann’s ischemia: It is due to the tight fascial compartment, a patient with the fracture of the both forearm bones & its is more susceptible to develop the acute compartmental syndrome.
Delayed union and nonunion: Delayed union and nonunion will be encountered thanks toinadequate immobilization and soft tissue interposition, , etc. it’s to can be treated by open reduction, rigid internal fixation and cancellous bone grafting.
Malunion: thanks to the complex muscular forces it’s difficult to retain the position of both bones in perfect alignment after closed reduction. it’s during this situation that malunion commonly results. it’s treated by corrective osteotomy, plating and bone grafting.
Cross union:This is often thanks to malunion of a radial fracture during a medially deviated position, And which occupies the interosseous space and blocks pronation and supination.if the cross-union takes place within the middle third of the forearm, and it are often left alone because the forearm is held in midpronation with less functional damage. Elsewhere, it needs corrective osteotomy and rigid internal fixation.