Forearm Fractures

It's difficult to separate the radius from the ulnar as you progress up the forearm but isolated fractures can occur. Forearm fractures frequently seen in school aged children after a fall.  Adult fractures may be markedly displaced with little or no bony contact between the fragments. ORIF needed

Isolated ulnar fracture
Rare but can happen if the arm is in a defensive position, as in martial arts. POP. If displaced or angulated, for ORIF.

Isolated radial fracture
Very rare

Monteggia Fracture

    

Ulnar fracture and radial dislocation. You need to look carefully at the radiocapitella line. If it does not transect the middle of the capitlellum, there is a radial head dislocation. Occurs by forced pronation of the outstretched forarm. Urgent ORIF needed.

The Hume fracture is related - anterior dislocation of the radial head + olecranon fracture.

Galeazzi - radial fracture, dislocation at distal radioulnar joint. This occurs in teenagers and is very rare.

http://www.pemcincinnati.com/blog/fracture-fridays-monteggiazzi/

Remember by:
" MUGR (Mugger): Monteggia Fracture = Ulnar fracture with radial head dislocation; Galeazzi Fracture = Radius fracture with DRUJ dislocation."

Olecranon Fractures

The Olecranon is the proximal part of the humerus. It is rare to fracture it. Olecranon fractures usually occur after
- direct blow or fall onto the elbow
- fall on outstretched hand with elbow flexed
- avulsion fracture
- stress fracture eg. throwing, weight lifting

Clinical Features
Significant amounts of elbow swelling
Inability to extend arm (due to triceps rupture)
Ulnar nerve injury possible

 




Radiological Findings
Fracture is normally obvious.

The radiological difficulty is differentiating fractures from the olecranon epiphysis. The olecranon epiphysis appears between the age of 8 and 11, and fuses by the age of 14.









Management
Undisplaced needs above elbow backslab, and fracture clinic.
Displaced or involving then elbow joint need an ORIF - so immediate orthopaedic opinion.

References
http://radiopaedia.org/articles/olecranon-fractures-1
http://radiopaedia.org/cases/olecranon-fracture-2
Oxford Handbook of Emergency Medicine
Minor Injuries
Musculoskeletal Trauma
Emergency Care of Minor Trauma in Children