Radius and ulna Fractures including Monteggia and Galeazzi FX. DX. By: M.H. Nouraei M.D. Isfahan University of medical sciences

Introduction: The forearm plays an important role in positioning of the hand in space by flexion and extension of the elbow and wrist as well as pronation and suspiration through the proximal and distal radioulnar joints. Fractures of the ulnar and radial shaft can therefore results in significant dysfunction if treated inadequately.

The incidence of distal radius fractures has increase over the past decades. However, the frequency of foream shaft fractures appears to be stable over time. The average yearly incidence inadults has been reported to be 1.35 per population ranging form 0 to 4 per population depending in age and gender. This is relatively infrequent compared to that of humerus shaft(0 to 10), femur (0 to 37). And tibia (0 to 21). Four- fifths of forearm shaft fractures occur in children. Above the age of 20 the rearly incidence of forearm shaft fractures remains below 2 per people, predominating in males throughout all age groups.

Mechanism of injury: High energy trauma Direct and indirect

Seqmental FX. Isolated ulnar FX. Gunshot froctures Direct Trauma Direct Trauma

Indirect Trauma: Bending forces can result to monteggia Tortional forces+ Axial loading ie(falling) (hyper pronation) Can lead to both bones fr(luterasseous membrance reoture) and TFCC(Triangular fibro cartilage complex) Axial loading ie(falling) (hyper pronation) Can lead to both bones fr(luterasseous membrance reoture) and TFCC(Triangular fibro cartilage complex)

Monteggia with posterior dislocation of radial head Hyper supination forces Monteggia with anterior dislocation of radial head Hyper pronation forces with outstretched hand

Associated injuries: One third (1/3) of forearm shaft fractures are isolated Two third (2/3) are with at least one associated inhuries Those are adjacent to forearm Those are other sites of muscle skeletal system Those are other organ systems Open fractures – Neurovascular– Injuries

Classification: -Bado -Open Fractures Gustillo - AO/OTH classification: identified with Number 22(2 for foream-2 for shaft) Type A: simple fractures Type B: wedge fractures Type C: complex fractures (comminuted or segmented )

Pathoanatomy and applied anatomy: -Osseous plane - Radius: in adults measures average 25 cm The nutrient artery of radius enters on the volar aspeet at average 9cm distal to radial head.(6-12 cm) Cancellors bone 4cm in proximal and 5 an in distal radius. Isthmus of endomeduldary canal is in mid point of radius.

Ulna: is the axis around which the radius rotates during supination and pronation -Greater sigmoid notch -Lesser sigmoid notch -F.C.U. and E.C.U -TFCC

Interosseous space: oval in shape -Greater distance Is in supination. -Interosseous membrane: anterior and posterior compartment -Interosseous ligament or central band: 20 degree obliquely and is constrain against radial shortening and after Radial head Resection.

Triangular fibrocartilage complex (TFCC) Serves as the medial continuation of the distal articular surface of the radius as well as static stabilizer of the distal radio ulnar joint. -Articular disc -Dorsal radioulnar ligament(DRUL) -Palmar radioulnar ligament(PRUL) -Meniscus homologue -Ulnar collateral ligament -Sheath of the ECU

DRUL. And PRUL, are the primary stabilizers of DRUJ and originates from dorsal and palmar aspect of sigmoid notch

Summary, controversies, and future O.R.I.F With nonlocking plate and screws High rate of union and satisfactory function Locking plate and intramedullary nailing No advantage