Radia ulna fracture

Background

• Requires great amount of force (vehicular trauma, falls from height, direct blow)
• Neurovascular complications are unusual
• One of the most common pediatric fractures

Clinical Features

• Pain/swelling, deformity
• Point tenderness

Differential Diagnosis

Forearm Fracture Types

• Distal radius fractures
  • Colles' fracture
  • Smith fracture
  • Barton fracture
  • Radial styloid fracture
  • Distal radioulnar joint disruption
• Radia ulna fracture
• Isolated radius fracture (proximal)
• Isolated ulna fracture (i.e. nightstick)
• Monteggia fracture-dislocation
• Galeazzi fracture-dislocation
• Forearm fracture (peds)

Evaluation

• Assess distal pulse, motor, and sensation
• Inspect skin for signs of open fracture

Imaging

• Always consider wrist and elbow films
• Assess for angulation
  • AP view: radial styloid and radial tuberosity normally point in opposite directions
  • Lateral view: ulnar styloid and coronoid process normally point in opposite directions

Management

General Fracture Management

• Acute pain management
• Open fractures require immediate IV antibiotics and urgent surgical washout
• Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
• Consider risk for compartment syndrome

Specific Management

• Rule-out compartment syndrome
  • Often admitted for obs, especially if prolonged reduction
• ORIF

Disposition

• If splinted and stabilized, can be discharged after consultation with Ortho
• Admit for:
  • Open fracture
  • Signs of neurovascular injury
  • Concern for compartment syndrome

See Also

• Forearm fractures