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The first 25 slides, exactly as they appear. The full deck has 102 content slides.
Orthopaedics
Fractures of the Ulnar and Radial Shaft
Built from Tang — Orthopaedic Trauma Vol 1: Upper Extremity
What’s inside
11 sections · 102 slides
Overview
- What this topic teaches you
The forearm as a rotating unit
- The big picture: why forearm fractures are special
- The forearm treated as an intra-articular fracture
- The goals of treatment, stated plainly
Applied anatomy of forearm rotation
- How much the forearm rotates, and how much you need
- Normal and functional range of forearm rotation
- The shapes of the two bones
- The radial arch: measuring the curve you must rebuild
- Measuring the maximum arc of the radius
- The proximal radioulnar joint: two key ligaments
- Ligaments of the proximal radioulnar joint
- The interosseous membrane: the forearm's load bridge
- Axial load sharing through the interosseous membrane
- The oblique cord and the neutral fixation position
- The distal radioulnar joint and the TFCC
- The triangular fibrocartilage complex of the wrist
- How the TFCC fibres keep the wrist stable
- Radius fractures often injure the distal joint
- The crankshaft radius and the rotation muscles
- Crankshaft radius and muscle-driven displacement
- Fracture site predicts the displacement
- The axis of forearm rotation
- The conical axis of forearm rotation
- Why radial length must be restored exactly
- The Henry muscle group: your window to the radius
- The Henry muscle group of the radial forearm
- The arcade of Frohse: protecting the deep radial nerve
- Arcade of Frohse and the deep radial nerve
How these fractures happen
- Direct violence: a blow straight to the bone
- Indirect violence: force travelling up the arm
- Mechanism of a Galeazzi fracture from a fall
Classifying the fractures
- The AO/OTA classification: three families
- AO Type A: simple forearm fractures
- AO Type B: wedge forearm fractures
- AO Type C: complex forearm fractures
- Monteggia fracture: the Bado classification
- Bado classification of Monteggia fractures
- Reading Monteggia types and Jupiter subtypes
- Galeazzi fracture: radius break plus joint injury
Assessing the injured forearm
- Clinical assessment, and the emergency not to miss
- Imaging: never image the forearm alone
- Full-length forearm imaging including wrist and elbow
- Signs of distal joint injury, and the role of CT
Surgical indications and aims
- Who needs surgery, and what surgery must achieve
Surgical approaches to the forearm
- Choosing the right approach for the injury
- Positioning and preparation
- Limb positioning for forearm surgery
- Planning the incisions on the skin
- Surface marking of the three forearm approaches
- The dorsal Thompson approach, step by step
- Dorsal Thompson approach to the radius
- The palmar Henry approach: superficial dissection
- Henry approach: superficial exposure of the radius
- The Henry approach: exposing each third of the radius
- Henry approach: level-by-level radius exposure
- The ulnar approach
- Direct dorsal approach to the ulnar shaft
Reduction and internal fixation
- Monteggia: reduce the ulna first
- Monteggia: ulnar reduction relocates the radial head
- Confirming and salvaging the radial head
- Proximal ulnar fracture with radial head dislocation
- Galeazzi: reduce the radius first and rebuild the arch
- Pre-shaped anatomical locking plates for the radius
- Galeazzi: check the distal joint, always
- Galeazzi fracture fixed with distal joint checked
- Managing an unstable distal radioulnar joint
- Double fractures: the order of fixation
- Both-bone forearm fracture fixed through two incisions
- Requirements for the final fixation
- Both-bone fracture fixed: reduction and compression
- When plate plus intramedullary fixation helps
- Combining plate fixation with intramedullary nailing
- Segmental forearm fracture: plate and elastic wire
- Postoperative treatment and rehabilitation
Complications and prevention
- Instability of the radioulnar joints
- Failed Monteggia fixation: radial head left dislocated
- A cautionary tale: never simply remove the radial head
- Elbow instability after radial head removal
- Nonunion and malunion: use anti-rotation plates
- Insufficient fixation strength leading to failure
- Cross-union (radioulnar synostosis) and its causes
- Radioulnar cross-union impairing forearm rotation
- Preventing cross-union
Bringing it together
- Three principles to remember
- Final takeaways
- References (1/5)
- References (2/5)
- References (3/5)
- References (4/5)
- References (5/5)
- Orthopaedic Trauma Surgery — Volume 1: Upper Extremity