1/3/2024 0 Comments V5261 hearing aidIsolated ulnar shaft fractures that are not displaced by more than 50 percent of the bone diameter and that are angulated less than 10 degrees can be treated with a short arm cast or a functional forearm brace for four to eight weeks. The physician must ensure that there is no associated dislocation of the radial head in fractures of the proximal one third of the ulna (i.e., Monteggia fracture), because these require orthopedic consultation. 16 Full evaluation requires posteroanterior and lateral radiography of the entire forearm, including the wrist and elbow. Commonly referred to as nightstick fractures, many ulnar shaft fractures are caused by a direct blow to a raised forearm. 6 Any cast or splint should not obstruct motion of the elbow, metacarpophalangeal joint, or fingers.Īlthough they are uncommon, isolated ulnar shaft fractures can be successfully treated with conservative methods. It is imperative to perform weekly radiography for the first three weeks because even fractures that appear stable may displace during early treatment, particularly in older patients. 5, 11, 12 The University of Ottawa, Ontario, Canada, offers video demonstrations of proper casting and splinting techniques at. Younger patients with good bone health and nondisplaced fractures often can be treated with a volar splint, whereas patients with minimal displacement or osteoporotic bone should have the extra protection of a short arm cast. Definitive treatment should be based on fracture characteristics and patient preferences. 5, 11, 12 Initially, a volar or sugar-tong splint may be necessary if there is significant swelling. If immediate confirmation or exclusion of fracture is required, or if there is a question about the presence of joint instability or associated ligamentous injury, magnetic resonance imaging may be performed.ĭistal radius fractures that are minimally displaced or impacted ( Figure 4) can be treated with immobilization for four to eight weeks. When suspicion of a fracture is high, it is appropriate to perform repeat radiography in 10 to 14 days. In the presence of recent trauma, patients with a visualized posterior fat pad and no other evidence of skeletal trauma should be treated as though a fracture has occurred. 8 The presence of a sail sign or a visualized posterior fat pad is evidence of a fracture or other intra-articular process ( Figure 1). A posterior fat pad is an abnormal finding. An anterior fat pad is normally visualized at the elbow, but an effusion will cause elevation of the fat pad (sail sign). Small, occult, or intra-articular fractures may not be noted on initial radiography. Oblique views can be used to supplement the basic series if the presence of a fracture remains in doubt. Standard radiography should include posteroanterior and lateral views. Much of the subsequent management is based on the radiologic evaluation of the fracture. Patients with an olecranon fracture are candidates for nonsurgical treatment if the elbow is stable and the extensor mechanism is intact. Mason type I radial head fractures can be treated with a splint for five to seven days or with a sling as needed for comfort, along with early range-of-motion exercises. Isolated ulnar fractures can usually be managed with a short arm cast or a functional forearm brace. Distal radius fractures with minimal displacement can be treated with a short arm cast. Initial management of forearm fractures should follow the PRICE (protection, rest, ice, compression, and elevation) protocol, with the exception of compression, which should be avoided in the acute setting. In the absence of these findings, many forearm fractures can be managed by a primary care physician. Fractures demonstrating significant displacement, comminution, or intra-articular involvement may also warrant orthopedic consultation. Open fractures, joint dislocation or instability, and evidence of neurovascular injury are indications for emergent referral. Proper initial assessment includes a detailed history of the mechanism of injury, a complete examination of the affected arm, and appropriate radiography. Fractures of the forearm are common injuries in adults.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |