.

(Injury of the wrist, forearm and elbow)

Colles Fracture, Smith Fracture, Galeazzi Fracture Monteggia Fracture

I. Colles Fracture Fracture distal end of radius fracture distal end of radius 100 radiocarpal joint 50 ) 50 Colles fracture Abraham Colles the fracture just an inch proximal to the (

(osteoporosis)

dorsiflexion, pronation (

1)

1: distal fragment energy trauma

Colles fracture radius dorsal displaced fracture distal end of radius

high

Clinical feature

(dinner fork deformity)

Radiographic feature

fracture distal end of radius stable unstable fracture distal articular surface of radius volar inclination

radial inclination ( 2)

11-23

0-11

2:

normal inclination of distal radius articular surface

non-displaced fracture distal end of radius Reverse mechanism of injury 6 displaced fracture distal end of radius congruity arthritis impaction deviation fracture distal radius (Hematoma block) anesthesia) Brachial plexus block local block (Gereral post traumatic longitudinal axis volar flexion ulna

Hematoma block Hematoma block close fracture open fracture Hematoma block (Sterile technique)

(longitudinal axis) (vertical distration force) (short arm cast) (Immobilization)

distal radius fracture)

(comminuted (collapse)

(articular

surface)

(External fixator)

(K-wire fixation)
bone graph

(Range of motion = ROM)

external fixator

Colles fracture 1. 2. 3. (Malunion) 4. Compartmental syndrome 5. Reflex sympathetic dystrophy

(ROM exercise)
malunion

malunion

(subluxation of radio-ulnar joint)

Reflex sympathetic dystrophy fracture distal end of radius Sudex reflex sympathetic dystrophy

II. Smith Fracture

Colles fracture

reverse Colles fracture Colles fracture

(dorsiflexion)
side flexion) Smith fracture Colles fracture dorsiflexion deviation ulnar volar side (reduction)

(radial deviation)

dorsal

(volar

III. Fracture Shaft of Radius and Ulnar Bone radius ulnar ulnar radius

distal radio-ulnar joint, proximal radio-ulnar joint interosseous membrane distal 1/3 of radius bone distal radio-ulnar joint Galeazzi fracture ulna proximal radio-ulnar joint Monteggia fracture dislocation

IV. Galeazzi Fracture Galeazzi fracture distal radio-ulnar joint Pronator quadratus

(pronation) distal (

distal supinator 3)

3:

Galeazzi fracture

(close reduction) ( ) immobilization (pronate)

distal radio-ulnar joint

fracture of necessity malunion plate screw distal radio-ulnar joint

(supination)

V. Fracture Proximal 2/3 of Radius 2 3

fracture radius

(Delay-union) (Non-union) (Mal-union)

VI. Fracture of Radius and Ulnar Bone Fracture of radius and ulnar bone

(indirect injury) (transverse fracture)

fracture) close reduction

(direct injury)

(oblique close reduction

(long arm cast)

malunion nonunion

close reduction cross union

VII. Monteggia Fracture Monteggia fracture radio-ulnar joint proximal ulna proximal radio-ulnar joint ulna proximal radius ulna

ulna radius humerus

4)

4: Monteggia fracture Galeazzi fracture

Monteggia fracture

ulna

proximal radio-ulnar joint arm cast) (supination)

(pin)

(long

VIII. Fracture & Dislocation of the Elbow 4

1. Fracture of the Humerus

Humerus biceps Humerus triceps 5)

5:

distal humerus

Humerus compound fracture bone marrow

(Coaptation splint)

6)

6:

Humerus

2. Supracondylar fracture

extension

flexion

tripod

olecranon, lateral compartment syndrome

medial epicondyle

closed reduction

Immobilization

slap

immobilization K-wire

slap

3. Dislocation of the elbow

10 2

(tripod) medial epicondyle

olecranon

lateral

immobilization

slap

90

slap

1 2-3

4. Fracture of the radial head

Radial head fracture distal radioulnar joint, interosseous membrane

Radial head

Mason

Radial head

25%

2
Radial head

Radial head

Radial head Radial head Radial head

3 Radial head
Radial head

4
Radial head Radial head

7)

7:

fracture radius head

IX. Throwing Injuries of the Elbow

1. 2. 3.

(forceful extension) (valgus stress) (pronation)

A.

A.1. Little league elbow A.2. Panner s disease A.3. Posterior extension and shear injuries syndrome

A.1. Little League elbow

(repetitive load)

1. (Medial epicondylar avulsion) 2. (delayed or accerelation apophyseal growth of the medial epicondyle) 3. (closure of epicondylar physis) 4. (osteochondrosis and osteochondritis) 5.

head

radial ulna nerve fragmentation, physeal widening

(Instability) (Stress fracture)

medial epiondylar avulsion 4-6

(Medial ligament ruptures)

over head sports

A.2. Panners Disease

Panners Disease (subchondrol bone) capitellum osteochondritis dissecans

7-12 13-16 (flexion contracture)

(loose body)

Panners disease Osteochondritis Dissecans

1
3-4

Capitellum

Capitellum

loose body

A.3. Posterior External and Shear Injuries Syndrome

posterior extension and shear injuries secondary ossification center of olecranon loose body

B.

Adult athletes

1. Tension overload of medial elbow 2. Hyperextension over load 3. Lateral epicondylitis

B.1. Tension Overload of Medial Elbow (tension over load of medial

elbow) instability hyperextension overload lateral compression

attachment) collateral ligament

(Medial epicondylar flexor group medial

valgus stress 15-250 medial collateral ligament palmaris longus ligament medial collateral

1. 2. 3. tension overload of medial elbow epicondylilits repetitive microtrauma medial epicondyle medial

(Provacative test)

steroid

medial epicondylitis ulnar nerve cubital tunnel ulnar tinels sign ulnar ulna ulnar ulnar

reacquet steroid ulnar

B.2. Hyperextension Overload

hyperextension loadover 1. Biceps

(repetitive trauma)
radius (radial

tuberosity)

2.

triceps

olecranon

steroid triceps 3. Olecranon bursitis 7-10 bursa bursa triceps

calcium

steroid bursa 4. olecranon olecranon fossa olecranon

CT scan

B.3. Lateral Epicondylitis

extensor

lateral epicondyle