If you fx one, usually the other as well or a dislocation.<\/p>\n
<\/p>\n
if you fx the radius, check the druj<\/p>\n
if you fracture the ulna, check the radial head<\/p>\n
<\/p>\n
X-ray at Elbow<\/p>\n
Radiocapitellar line-line through center of radius should pass through center of capitellum<\/p>\n
Fat Pads-large anterior or any posterior=radial head fx<\/p>\n
Anterior Humeral Line through middle of capitellum<\/p>\n
Radial Head<\/p>\n
Assess radial nerve, valgus instability<\/p>\n
Olecranon All considered intraarticular<\/p>\n Can\u0092t extend the forearm<\/p>\n Document Ulnar Nerve function<\/p>\n If wrist pain, consider DRUJ disruption (Essex-Lopresti Fx\/Disloc)<\/p>\n Coronoid Fxs-antecubital tenderness<\/p>\n Rx:\u00a0 splint in 50 to 90 flexion at elbow, wrist in neutral<\/p>\n Radial Shaft<\/p>\n Signs of Rupture of DRUJ<\/p>\n 1.\u00a0\u00a0\u00a0\u00a0\u00a0 Fx of Ulna Stylus<\/p>\n 2.\u00a0\u00a0\u00a0\u00a0 Widenening of Joint Space<\/p>\n 3.\u00a0\u00a0\u00a0\u00a0 Dislocation of the radius 4.\u00a0\u00a0\u00a0\u00a0 Shortening of the radius<\/p>\n GFR as mnemonic<\/p>\n Fx of distal 1\/3 of the radius c DRUJ Dislocation (tenderness or ulnar prominence)<\/p>\n Splint these c post\/ant long arm splint with elbow at 90\u00ba and wrist in supination<\/p>\n Ulna<\/p>\n Monteggia\u0092s-prox 1\/3 ulna c radial head dislocation.<\/p>\n Check for radial nerve damage<\/p>\n Get Consult<\/p>\n Both Bone Fractures<\/p>\n Ortho consult in adults<\/p>\n Buckle in kids can be splinted<\/p>\n Peds<\/p>\n Greenstick on Shafts<\/p>\n Buckle in the Metaphysis<\/p>\n Distal Forearm<\/p>\n Colles\u0092<\/strong>-dinner fork deformation.\u00a0 Caused by fall on outstretched arm into extension of wrist, fx of radius<\/p>\n ? assoc. ulna styloid fx<\/p>\n ? radioulnar joint involvement<\/p>\n ? radiocarpal joint involvement<\/p>\n Check for median and ulna nerve damage and extensor pollicis longus<\/p>\n Splint wrist in 15 degrees of flexion and 15 degrees of ulna deviation.<\/p>\n Smith\u0092s<\/strong>-same idea but flexion injury<\/p>\n Normal Wrist Anatomy<\/p>\n <\/p>\n Using the \u0093DOH\u0094 mnemonic, there are three high-risk \u0093D\u0094islocations of the wrist. In increasing order of severity, they include scapholunate dissociation, perilunate dislocation, and lunate dislocation. First, scapholunate dissociation is the most common ligamentous injury of the wrist. This injury occurs when a person falls on an outstretched hand, which causes a ligamentous disruption between the scaphoid and lunate bones. The scaphoid undergoes rotatory subluxation into a more transverse orientation. The primary radiographic finding is the presence of at least a 5 mm widening of the scapholunate space, named the \u0093Terry Thomas sign\u0094<\/p>\n <\/p>\n <\/p>\n The second \u0093D\u0094 injury is a perilunate dislocation (Figure 4). This injury occurs with hyperextension of the wrist and can best be visualized on the lateral radiographic view. The lunate no longer smoothly articulates with the capitate distally. Complications of an undiagnosed perilunate dislocation include permanent median nerve damage and scapholunate advanced collapse (SLAC). SLAC occurs when the scaphoid and\/or lunate undergoes avascular necrosis and consequently collapses, causing debilitating and chronic pain.<\/p>\n <\/p>\n And the third \u0093D\u0094 injury is lunate dislocation (Figure 5). The mechanism involves falling backwards on an outstretched hand. Best visualized on the lateral radiograph, the lunate disarticulates with both the distal radius and the capitate. This misalignment resembles a \u0093spilled teacup.\u0094 A missed lunate dislocation has similar devastating consequences as a perilunate dislocation with median nerve damage and SLAC. Most perilunate and lunate dislocations will fail closed-reduction maneuvers and will require an emergent orthopedic consultation for open reduction and internal fixation.<\/p>\n <\/p>\n There are two frequently missed \u0093O\u0094ccult fractures of the wrist.\u00a0 First, scaphoid fractures comprise the second most commonly fractured bone of the wrist, following the distal radius (9).\u00a0 In a study by Freed and Shields, 13% of scaphoid fractures were missed initially, thus, giving scaphoid fractures the highest \u0093miss rate\u0094 of all fractures in their ED (10).\u00a0 Patients usually have fallen on their outstretched hand and complain of pain in the anatomical \u0093snuffbox\u0094 region of the wrist.\u00a0 Radiographic findings may include a subtle cortical break seen on the PA view (Figure 6); however, up to 20% of scaphoid fractures may be radiographically occult (11).\u00a0 Consequently, all patients with \u0093snuffbox\u0094 tenderness require immobilization and referral to an orthopedist, regardless of a normal radiograph.\u00a0 Complications of a missed scaphoid fracture include avascular necrosis of the scaphoid, nonunion especially when treatment is delayed for more than four weeks 12 and SLAC.<\/p>\n Figure 6.\u00a0 Scaphoid fracture of right wrist (PA view with ulnar deviation view) <\/p>\n![\"\"](\"\/wp-content\/images\/part1\/elbow.jpg\")
<\/a><\/p>\n<\/a><\/p>\n<\/span>Galeazzi<\/span><\/h3>\n
<\/span>Radiology<\/span><\/h2>\n
<\/a><\/a><\/p>\n<\/a><\/a><\/p>\n<\/a><\/a><\/p>\n<\/a><\/a><\/p>\n<\/a><\/a><\/p>\n<\/a>\u00a0 <\/a><\/strong>The second \u0093O\u0094ccult fracture involves the triquetrum bone (Figure 7).\u00a0 Accounting for 10% of all carpal bone fractures, it occurs when a patient falls on an outstretched hand and has tenderness over the ulnar aspect of the dorsal wrist.\u00a0 It is frequently misdiagnosed as a wrist sprain.\u00a0 Anatomically, the triquetrum is the most dorsal carpal bone, and radiographically the ulnar styloid \u0093points\u0094 to it on the lateral view.Figure 7.\u00a0 Triquetrum fracture of right wrist (Oblique view) <\/a>\u00a0 <\/a><\/strong>And the last letter of the \u0093DOH\u0094 mnemonic stands for finding \u0093H\u0094alf of the injuries only.\u00a0 Often times the most obvious fracture is noted, while the second concurrent injury, such as a dislocation, is overlooked.\u00a0 In the wrist, this is the case in a Galeazzi fracture-dislocation (Figure 8) \u0096 a distal-third radial fracture with an associated disruption of the distal radioulnar joint (DRUJ).\u00a0 In a DRUJ disruption, the lateral radiograph can show the distal ulna no longer overlying the distal radius and\/or the ulnar styloid no longer pointing to the dorsal triquetrum.\u00a0 Further on the PA view, a widened DRUJ space and\/or an ulnar styloid fracture similarly suggests a DRUJ disruption.\u00a0 Major complications in diagnosing a patient with a simple radius fracture instead of a Galeazzi fracture-dislocation include chronic wrist joint arthritis and painful disability.\u00a0 It is thus crucial to examine the DRUJ before discharging a patient with the diagnosis of an isolated distal-third radius fracture.Figure 8.\u00a0 Galeazzi fracture-dislocation of the wrist (Lateral view) <\/a>\u00a0\u00a0 <\/a><\/strong>More distally, radial fractures are also associated with carpal injuries.\u00a0 Because distal radius fractures are frequently caused by a fall on an outstretched hand, scapholunate dissociations often occur concurrently.\u00a0 A small retrospective study of 52 patients found that 69% of distal radius fractures were associated with scapholunate dissociations (13).\u00a0 Additionally, intra-articular radial styloid fractures are frequently associated with carpal ligamentous injuries in addition to fractures of the scaphoid and lunate bones.<\/p>\n