Fraktur radius, fraktur ulna, fraktur colles

Fraktur radius, fraktur ulna, fraktur collesNs. Ahmad Hasyim W, M.Kep, MN, CWCC

Anatomy of the radius

Capitulum radiiCollum radiiProcessus styloideus

Depan BelakangCapitulum radiiProcessus styloideusAnatomy of the ulna

OlecranonProcessus coronoideusProcessus styloideus

OlecranonProcessus coronoideusDepan SampingIncisura trochlearis

A. RadialisA. UlnarisN. MedianusRadius and ulna movementTypes of FracturesMonteggia fracture Galeazzi fracture Distal Radial Fracture (Colles Fracture)Isolated Ulnar/RadiusMonteggiaBUM: Broken Ulnar MonteggiaFracture of ulna with dislocation of the radial head. 1 in 14 of forearm More common in children. Adult injuries are typically high energy, fall from heights or MVA.

Clinical Evaluation: Pain and swelling in the elbow and ulnar border of the forearm. ROM limited by pain. NeuroVascular exam, evaluate for compartment syndrome, evaluate soft-tissue envelope, wrist evaluation.

MonteggiaRadiology: A/P and Lateral of forearm +/- elbow, wrist. Always suspect a radial head dislocation in an ulnar fracture.

A line drawn along the axis of the radius should pass through the capitellum on both lateral + AP views.

MX: ORIF generally.

GaleazziGFR: Galeazzi Fractured Radius

Definition: Fracture of the radial shaft (usually distal 1/3) with dislocation of the distal radioulnar joint

Clinically: Pain and swelling in forearm and wrist. Forearm rotation very painful.NV exam, evaluate for compartment syndrome, evaluate soft-tissue envelope, wrist evaluation.

Galeazzi part 2Radiologically: A/P and Lateral of forearm +/- elbow, wrist.

Mx: ORIF of the radius is indicated in all cases. Further Mx depending on stability of distal radioulnar joint.

Assoicated injuries/DDx:Ulnar Styloid Fracture TFCC Tear DRUJ Instability

Isolated Ulnar/RadiusMost fractures of the ulnar/radius shaft are caused by direct blows and result in minimal soft-tissue injury. Generally obvious gross deformity NV exam, evaluate for compartment syndrome, evaluate soft-tissue envelope, wrist evaluation.A/P and Lateral of forearm +/- elbow, wrist.

Isolated Ulnar/RadiusUlnar Shaft Fracture Associated Injuries / Differential DiagnosisMonteggia fracture-dislocation. Radius and ulna shaft fracture. Galeazzi Fracture

Mx: Depends on if its a distal, middle or proximal third. Plus if its displaced or not. Can be conservative or ORIF.

Distal Radial Fracture (+ Colles Fracture)Most commonly women age 60-70. 90% caused by compression on dorsiflexed wrist. 90% of distal radius fractures are Colles Fractures

Colles FractureDefinition: Dorsally displaced fracture of the distal radius generally occuring 2-3 cm proximal to the radiocarpal joint. Most common fracture, seen mainly in middle aged and elderly women. Clinical Evaluation: Pain and swelling in wrist, often gross deformity in wrist.

Colles FractureMx: Can be generally managed with closed reduction with well molded cast/splint.Significant angulation and deformity may require an open reduction and internal fixation. An open fracture will always require surgical intervention. Consider Osteoporosis evaluation and management.

Fracture ComplicationsSuperficial wound infection Nonunion: (incidence is higher for comminuted or displaced fx's) Compartment syndromeMalunion PainfulUlnar nerve palsy Radial nerve palsy

Treatment optionsClosed reduction and immobilizationClosed reduction and Percutaneous pinningExternal fixationORIF with plate fixationBone graftingTreatment GoalsAnatomical reduction should be the goalClosed reduction and immobilization

Closed reduction and Percutaneous pinning

(K-wire )External fixation

ORIF with plate fixation

Nursing DiagnosesAcute painRT bone or joint damageCharacterised by: Guarding, moaning, crying, restlessness, altered muscle tone, decreased activity; Statement of painNOC: Pain level (indicators: scale, pqrst, complaint)NIC: Pain ManagementIntervention: Reduce mobility, warm application, deep breathing, relaxationCollaborative: analgesia, sedative, traction

22Nursing DiagnosesImpaired tissue integrityRT: physical trauma, infection processCharacterised by: cutaneous wounds (with pus, odor, nonviable tissue)NOC: Tissue Integrity: Skin & Mucous MembraneNIC: Wound CareCleanse the wound, wound assessment, debride nonviable tissue, apply appropriate dressing

Nursing DiagnosesImpaired physical mobilityRT Pain, immobilization devices, weight-bearing limitationsCharacterised by : Inability or unwillingness to change positions NOC: Mobility

NIC: Exercise TherapyActive or passive body movement, support mobilisation

24Thank you!