Forearm FX Info

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Forearm Fractures

Source: Silverman, FN. Caffey’s Pediatric X-Ray Diagnosis. Eighth Ed. Chicago: Year Book Medical Pub, Inc., 1985.

Upper extremity injuries are commonly associated with blunt trauma. In such injuries, bones of the forearm are frequently fractured, the radius being more commonly fractured than any other long bone in the body. During the secondary survery, the upper extremity should be examined for deformity, swelling, pain, problems in range in motion, and neurovascular and peripheral nerve status. In the case of injury to the radius and/or ulna, testing of the median, ulnar, and radial nerve should be preformed. Positive findings during the secondary survery may necessitate x-ray studies to determine the extent of the injury. For the purposes of classification, orthopedic injuries of the forearm may be broken into three categories, which are then subdivided based on the dynamics of the injury.

Salter Harris Physeal Fractures:

A Salter Harris fracture involves fracture of the physis, which is the growth plate and only present in children. The fracture line may extend into the metaphysis, epiphysis, or both.

  • Type I — Fracture through the physis (widened physis).
  • Type II — Fracture partially through the physis extending up into the metaphysis.
  • Type III — Fracture partially through the physis extending down into the epiphysis.
  • Type IV — Fracture through the metaphysis, epiphysis, and physis. (This pattern may led to angulation deformities during healing.)
  • Type V — Crush injury to the physis.

In both Salter Harris III and Salter Harris IV type injuries, the fracture is intra-articular.

Monteggia Fractures (info. for those interested in orthopedic surgery):

A Monteggia fracture occurs when the ulna is fractured along with dislocation of the radial head. There are several types of Monteggia type fractures depending on the relative positioning of the radius and ulna:

  • Type I — Anterior angulation of the ulna, with anterior dislocation of the raidal head.
  • Type II — Posterior angulation of the ulna, with posterior dislocation of the radial head.
  • Type III — Lateral angulation of the ulna, with lateral dislocation of the radial head.
  • Type IV — Proximal fractures of radial and ulnar shafts, with anterior dislocation of radial head.

Most commonly breaks of the ulna are accompanied by anterior dislocation of the radial head when the elbow joint is in extension. Conversely, when the elbow is in flexion and the ulna is fractured, posterior dislocation of the radius is more common (Monteggia fractures with posterior dislocation of the radius are also known as “reversed Monteggia fractures”).

Galleazzi Fractures (info. for those interested in orthopedic surgery):

A Galleazzi fracture involves fracture of the radius with associated distal radioulnar dislocation. In pediatric patients, it is possible to have a “Galleazzi variant” wherein a physeal fracture of the distal ulna acts similar to a distal radioulnar dislocation — the hand and carpus remain with the ulnar epiphysis and distal radius to which it is still attached.

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