Ulnar fracture surgery: Difference between revisions
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In he age of 10-12 years in girls and 12-14 years in boys the surgical treatment must be strongly considered for displaced fractures of the forearm. Children aged 10 years or older with proximal-third radius fractures and ulna angulation less than 15º seem to be at highest risk for failure when treated nonoperatively for both-bone forearm fractures. | In he age of 10-12 years in girls and 12-14 years in boys the surgical treatment must be strongly considered for displaced fractures of the forearm. Children aged 10 years or older with proximal-third radius fractures and ulna angulation less than 15º seem to be at highest risk for failure when treated nonoperatively for both-bone forearm fractures. | ||
== | ==Surgery== | ||
When both bones of the forearm are fractured, they are both exposed and provisionally reduced before fixation of either bone is completed. The fracture with the least comminution (usually the ulna) is fixed first. After reduction and provisional fixation of both bones, pronation and supination are examined; if normal, definitive fixation is performed. The general rule is that bone grafting is recommended when more than one third of the circumference of the bone is comminuted. | When both bones of the forearm are fractured, they are both exposed and provisionally reduced before fixation of either bone is completed. The fracture with the least comminution (usually the ulna) is fixed first. After reduction and provisional fixation of both bones, pronation and supination are examined; if normal, definitive fixation is performed. The general rule is that bone grafting is recommended when more than one third of the circumference of the bone is comminuted<ref name="pmid30224208">{{cite journal |vauthors=Stragier B, De Smet L, Degreef I |title=Long-term follow-up of corrective ulnar osteotomy for missed Monteggia fractures in children |journal=J Shoulder Elbow Surg |volume=27 |issue=11 |pages=e337–e343 |date=November 2018 |pmid=30224208 |doi=10.1016/j.jse.2018.06.029 |url=}}</ref><ref name="pmid29527237">{{cite journal |vauthors=Dey Hazra RO, Lill H, Jensen G, Imrecke J, Ellwein A |title=Fracture-pattern-related therapy concepts in distal humeral fractures |journal=Obere Extrem |volume=13 |issue=1 |pages=23–32 |date=2018 |pmid=29527237 |pmc=5834588 |doi=10.1007/s11678-018-0442-8 |url=}}</ref>. | ||
The common therapeutic options in orthopedic medicine for ulnar fractures are<ref name="pmid30233979">{{cite journal |vauthors=Kocheta A, Agrawal Y |title=Landmark Technique for a Wrist Block |journal=JBJS Essent Surg Tech |volume=8 |issue=1 |pages=e7 |date=March 2018 |pmid=30233979 |pmc=6143305 |doi=10.2106/JBJS.ST.16.00082 |url=}}</ref><ref name="pmid29169602">{{cite journal |vauthors=Shearin JW, Chapman TR, Miller A, Ilyas AM |title=Ulnar Nerve Management with Distal Humerus Fracture Fixation: A Meta-Analysis |journal=Hand Clin |volume=34 |issue=1 |pages=97–103 |date=February 2018 |pmid=29169602 |doi=10.1016/j.hcl.2017.09.010 |url=}}</ref><ref name="pmid28664232">{{cite journal |vauthors=Siebenlist S, Braun KF |title=[Elbow dislocation fractures] |language=German |journal=Unfallchirurg |volume=120 |issue=7 |pages=595–610 |date=July 2017 |pmid=28664232 |doi=10.1007/s00113-017-0373-7 |url=}}</ref><ref name="pmid28314869">{{cite journal |vauthors=Babst R, Schraner C, Beeres FJ |title=[Operative treatment of terrible triad injury of the elbow : Open reduction and internal fixation] |language=German |journal=Oper Orthop Traumatol |volume=29 |issue=2 |pages=125–137 |date=April 2017 |pmid=28314869 |doi=10.1007/s00064-017-0489-5 |url=}}</ref><ref name="pmid27620542">{{cite journal |vauthors=Guss MS, Kaye D, Rettig M |title=Bennett Fractures A Review of Management |journal=Bull Hosp Jt Dis (2013) |volume=74 |issue=3 |pages=197–202 |date=September 2016 |pmid=27620542 |doi= |url=}}</ref>: | |||
* Open reduction and internal fixation with plates and screws | |||
Known as the most common type of surgical repair for forearm fractures. | |||
* Open reduction and internal fixation with rods | |||
* External fixation | |||
The indications for intramedullary nailing are : | The indications for intramedullary nailing are : | ||
* Segmental fractures | |||
Segmental fractures | * Poor skin condition | ||
Poor skin condition | * Selected nonunions or failed compression platings | ||
Selected nonunions or failed compression platings | * Multiple injuries | ||
Multiple injuries | * Diaphyseal fractures in osteopenic patients | ||
Diaphyseal fractures in osteopenic patients | |||
==References== | ==References== | ||
Latest revision as of 13:50, 26 October 2018
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Ulnar fracture surgery On the Web |
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American Roentgen Ray Society Images of Ulnar fracture surgery |
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Risk calculators and risk factors for Ulnar fracture surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2] ;
Overview
In he age of 10-12 years in girls and 12-14 years in boys the surgical treatment must be strongly considered for displaced fractures of the forearm. Children aged 10 years or older with proximal-third radius fractures and ulna angulation less than 15º seem to be at highest risk for failure when treated nonoperatively for both-bone forearm fractures.
Surgery
When both bones of the forearm are fractured, they are both exposed and provisionally reduced before fixation of either bone is completed. The fracture with the least comminution (usually the ulna) is fixed first. After reduction and provisional fixation of both bones, pronation and supination are examined; if normal, definitive fixation is performed. The general rule is that bone grafting is recommended when more than one third of the circumference of the bone is comminuted[1][2].
The common therapeutic options in orthopedic medicine for ulnar fractures are[3][4][5][6][7]:
- Open reduction and internal fixation with plates and screws
Known as the most common type of surgical repair for forearm fractures.
- Open reduction and internal fixation with rods
- External fixation
The indications for intramedullary nailing are :
- Segmental fractures
- Poor skin condition
- Selected nonunions or failed compression platings
- Multiple injuries
- Diaphyseal fractures in osteopenic patients
References
- ↑ Stragier B, De Smet L, Degreef I (November 2018). "Long-term follow-up of corrective ulnar osteotomy for missed Monteggia fractures in children". J Shoulder Elbow Surg. 27 (11): e337–e343. doi:10.1016/j.jse.2018.06.029. PMID 30224208.
- ↑ Dey Hazra RO, Lill H, Jensen G, Imrecke J, Ellwein A (2018). "Fracture-pattern-related therapy concepts in distal humeral fractures". Obere Extrem. 13 (1): 23–32. doi:10.1007/s11678-018-0442-8. PMC 5834588. PMID 29527237.
- ↑ Kocheta A, Agrawal Y (March 2018). "Landmark Technique for a Wrist Block". JBJS Essent Surg Tech. 8 (1): e7. doi:10.2106/JBJS.ST.16.00082. PMC 6143305. PMID 30233979.
- ↑ Shearin JW, Chapman TR, Miller A, Ilyas AM (February 2018). "Ulnar Nerve Management with Distal Humerus Fracture Fixation: A Meta-Analysis". Hand Clin. 34 (1): 97–103. doi:10.1016/j.hcl.2017.09.010. PMID 29169602.
- ↑ Siebenlist S, Braun KF (July 2017). "[Elbow dislocation fractures]". Unfallchirurg (in German). 120 (7): 595–610. doi:10.1007/s00113-017-0373-7. PMID 28664232.
- ↑ Babst R, Schraner C, Beeres FJ (April 2017). "[Operative treatment of terrible triad injury of the elbow : Open reduction and internal fixation]". Oper Orthop Traumatol (in German). 29 (2): 125–137. doi:10.1007/s00064-017-0489-5. PMID 28314869.
- ↑ Guss MS, Kaye D, Rettig M (September 2016). "Bennett Fractures A Review of Management". Bull Hosp Jt Dis (2013). 74 (3): 197–202. PMID 27620542.