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Management of Fracture Both Bones Forearm

  1. Fracture both bones of forearm may result in severe loss of function unless adequately treated by restoring normal relationship of radius and ulna. The relationship of radio humeral, ulno humeral, proximal radioulnar, radio carpal and distal radioulnar joints and the interosseous space must be anatomical or some functional impairment will occur.
  2. In addition to regaining length, and axial alignment (by reducing angulation), achieving normal rotational alignment is necessary if a good, range of pronation & supination is to be restored.
  3. Forearm rotation is vulnerable to any malalignment of radius and accurate rotational as well as axial reduction is necessary.
  4. Malunion and nonunion occur more frequently because of the difficulty in reducing and maintain the reduction of two parallel bones in the presence of pronating and supinating muscles that have angulatory and rotational influences.
  5. Because of these factors OR & IF (by plating) of displaced diaphyseal fractures in adult is accepted as best method of treatment.
  1. Mechanism of Injury
    1. A twisting force (usually fall on hand) produce spiral fracture with both bones broken at different level (radius usually at higher level).
    2. A direct blow or angulating force causes a transverse fracture of both bones at the same level.
  2. Rotational Deformity In fracture Shaft Radius (Produced by muscle Pull)
    1. Biceps & supinator for muscles, both of which are supinators, are inserted into upper third of the shaft of radius. Pronator Teres is inserted into the middle third of bone and pronator Quadratus into the lower third.
  3. Treatment Rationale
    1. A fracture of shaft of radius at the junction of upper & middle thirds proximal to pronator leres is therefore situated between two groups of muscles.
    2. The proximal fragment has only supinators inserted into it and the distal fragment has only pronators. Thus causing supination of proximal fragment and pronation of distal fragment.
    3. Fractures of upper third of radius are, therefore, should usually be immobilized with the hand and forearm supinated, so that the distal fragment is rotated into the same axis as the proximal fragment.
    4. If the fracture is at, or below, the middle third (distal to pronator teres) of the bone, the proximal fragment has both supinators and pronators muscles attached to it.
    5. It therefore takes up the mid position half way between full supination and full pronation, and this forearm fracture should usually be immobilized with the hand & forearm in the mid (neutral) position.

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