1. FRACTURES AND DISLOCATIONS OF HAND AND FOREARM
K.MOZAFARIAN

2. COMMON TERMINOLOGY DEFINITION OF FX;
SITE OF FX: side, bone anatomic location
Type of fx: trans, short oblique, spiral, comminuted, segmental, buterfly
Angulation
Translation or displacement
Overriding
Rotation

3. Radial head fractures Type 1: nondisplaced Type 2: partial displaced
displacement < 2mm
displacement >2mm
Type 3: total comminuted

4. Treatment
All type one and most type 2 fractures : sling , immediate motion
Some type 2 fractures that blocs rotation, some partial fx c displacement >2mm and repairable c fracture dislocations of forearm and elbow : ORIF
Comminuted fx : excision , prosthesis in case of elbow or forearm instability or in most young pt

5. Deforming forces
Pronator quadratus
Pronator teres
Supinator
Biceps

6. FX OF RADIUS AND ULNAR SHAFT
Anatomic reduction is mandatory (no rotation ,no angulation)
Otherwise it results in severe loss of function
Open reduction and internal fixation is always indicated

7. Treatment plan
ORIF by plate and screws
ORIF by intra medulary rod

8. Forearm shaft fracture in children
Long arm cast except for stable distal third fractures in >4y/o child which is treated by short arm cast
Duration: 6-8 wks, more time in bayonet position
Few more weeks of splinting until the transverse lucent sign disappear and all 4 cotices has union

9. Acceptable reduction Angulation: Distal 3rd : 20 degree
Middle 3rd : 15 degree
Proximal 3rd: 10 degree
Provided that 2 y of growth remaining
Translation 100 percent if shortening is <1 cm
Rotation: up to 45 degree

10. Complications:
1- Redisplacement : the most common, occure in 10% 2-forearm stiffness:18-72% show at least mild deficits, mostly pronation contracture, 3- Refracture: more than any other fracture, 4-8%, average at 6 m, male 3times than female, older children ( 12 y/o), diaphyseal, Treatment is ORIF by some authors but others are ifo closed reduction

11. Complications
4- Malunion 5- Delayed and nonunion 6- Cross union

12. MONTEGGIA FX-DISLOCATION
FX of the proximal or middle third of the ulna with dislocation of the radial head

13. Types of the Monteggia fx- dislocation

14. Treatment
Ulnar fx : open reduction and internal fixation by plate and screws or by tension band wiring
Radial head dislocation: open reduction when it can not be reduced by reduction of the ulnar fx

15. Galeazzi fx- dislocation
Fx of the distal radius with dislocation of the ulnar head
It should be treated by open redution and internal fixation as the rule

16. Fx of distal radius A- Extraarticular fx:
COLLES FX: dorsal displacement and
volar angulation
SMITH FX: dorsal angulation and volar
displacement

17. Colles fracture
Dorsal displacement and volar angulation

18. Treatment of extraarticular fx
Extra articular fx can usually be treated by closed redution and casting
If the reduction can not be obtained by closed methods open reduction and internal fixation by pins or plate is indicated
If reduction is obtained but is unstable PCP or external fixator is the Rx of choice

19. Acceptable reduction of the distal radius

20. Acceptable reduction

21. Intra articular fractures
Intraarticular fx should usually be treated by PCP or external fixator
Anatomical reduction of the articular surface is mandatory for good results

22. Carpal bone fractures
Scaphoid fx is the most common fracture of the carpus
Circulation of the scaphoid is from distal to proximal
Chance of avascular necrosis and nonunion is higher

23. Scaphoid fracture Diagnosis of the fracture
Radiographic examination: PA- LAT-AP with 30 degree supination and ulnar deviation(scaphoid view)
Fx displacement can be demonstrated by motion series

24. Types of fracture

25. Treatment of scaphoid fracture
Undisplaced fractures: thumb spica cast for 12 weeks
Displaced fractures : step>1mm
S-L angle>60
lunocapitate>15
-closed reduction and thumb spica
-otherwise : open reduction and pin or screw fixation

26. LUNATE FRACTURE ; KIENBOCK DISEASE

28. Lunate fracture: Kienboch disease

29. Hand fractures Fx of metacarpal bones Fx of proximal phalanx
Fx of distal phalanx
Fx of middle phalanx
Multiple fx
Open fx

30. Hand fx