Thursday, January 9, 2014

OUCH! Forearm Fractures Board Review

Author: Meaghan Mercer, DO; AAEM/RSA President

Galeazzi Fractures: A typically isolated radial fracture with subluxation or dislocation of the ulnar head.
  • Injury to a division of the median nerve known as the anterior interosseous nerve (AIN) can occur.
  • AIN palsy can cause paralysis of the flexor pollicis longus and flexor digitorum profundus muscles.
        o Clinical manifestations: loss of the pinch mechanism between the thumb and index finger, ability to pronate forearm, and the ability to flex the thumb, index, and middle fingers.
  • Requires open reduction and internal fixation (ORIF) in adults

Monteggia Fractures: Fracture of the proximal ulna with dislocation of the radial head.
  • Similar nerve injury pattern to Galeazzi fractures with an increased risk of ulnar nerve involvement.
        o Clinical manifestations: ring and pinkie finger flexion, finger abduction/adduction
  • Requires ORIF in adults
  •  Most nerve injuries resolve within six months.
Nightstick Fractures: Non-displaced fracture of the ulnar shaft usually resulting from a direct blow
  • Management: elbow X-rays to rule out Monteggia fracture
  • Stable if <50% displaced and can be braced
A full neurovascular exam is indicated in all of these fractures!
  • Remember to rule out compartment syndrome

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