Radial / Ulnar Fractures
Radial head #
MOI: FOOSH; most common # of elbow; often assoc inj (eg. Capitellum /olecranum / coronoid #, MCL inj, med
epicondyle #)
Classification: I Displaced <2mm; no mechanical block
II Displaced <2mm; >30% radial head involvement; maybe mechanical block
III Comminuted
IV + dislocation
Others: hairline, marginal, segmental
OE: localised tenderness over # site; incomplete elbow extension; pain on pronation / supination
Mng: sling and mobilise; OT if >1/3 articular surface involved / >30deg angulation / >3mm
depression / mechanical block / comminuted
Radial neck #
Complications: NV complications uncommon
MOI: FOOSH
OE: tenderness more distal; less pain
Mng: sling if no angulation (up to 30deg allowed in children); manipulate if >20deg angulation with
traction, supination and pronation; OT if gross displacement / epiphyseal inj
Olecranon #
Mid-shaft #’s
Nightstick #
Monteggia
#
Intra-articular so require careful reduction
Classification: I Displaced <2mm; trt conservatively
II Displaced but ulnohumeral joint stable; needs OT
III Displaced and unstable
OT if: displaced, unstable; >10deg angulation, or subluxation of prox / distal radioulnar joint
Midshaft ulna due to direct blow; needs POP 6-8/52; ORIF if >50% displaced or
>10deg angulation or prox 1/3
Fracture prox 1/3 ulna with dislocated radial head (anteriorly in 60%)
MOI: FOOSH
Complications: interosseous and radial nerve inj; malunion and nonunion; unstable radial
head
Mng: ORIF; can be managed closed in children
Galeazzi #
Reverse Monteggia; # midshaft or distal 1/3 radius with dsilcated distal
radioulnar joint; 3x more common than Monteggia
MOI: FOOSH
XR: radial styloid should project 8-18mm distal to radioulnar jt; distal radius should
articular with at least ½ lunate; ulna and radius should be meet to form smooth jt
surface
Shortening of radius by 5mm; # ulnar styloid process (60%); widened distal
radioulnar jt space by 2mm; subluxation of distal radioulnar jt
Complications: malunion, nonunion, instability of DRUJ; damage to ulnar nerve
and ant interosseous branch of median nerve
Mng: ORIF
EssexLopresti #
Fractured radial head and dislocation of distal
radioulnar jt
Hume #
Fractured olecranon with radial head
dislocated anteriorly
Colles #
Transverse # distal radius 4cm prox to wrist, with dorsal + radial angulation
and displacement; possible prox displacement and dorsal comminution;
assoc ulnar styloid # in 60% (always give it a pull if this is present as suggests
serious disruption of inf radio-ulnar joint); may be intra-articular extension
Give it a pull if: >10deg dorsal angulation; >5deg radial
angulation; 2-5mm radial shortening; intra-articular step >2mm
 traction, extension, 10deg flexion, full ulnar deviation  POP 5-6/52
OT if: >20deg dorsal angulation; >5mm radial shortening; >1cm displacement; >50% dorsal
comminution; palmar metaphseal comminution; intra-articular disruption; assoc ulna/carpal #;
severe OP; assoc NVI or tendon inj; shearing #; open; impaired contralateral wrist; splitting of
radial fragment; failed conservative trt
Complications: shoulder + wrist stiffness (30%); median nerve compression (5-10%; palmar paraesthesia; if still
present after pull, OT); malunion (5%); delayed union (1-2%); nonunion (0.2%); complex regional pain syndrome (14%); EPL rupture (3%; due interrupted vascular supply; occurs 4-8/52 later); compartment syndrome (0.25%; usually
anterior); triangular fibrocartilage complex inj; radioulnar and radiocarpal instability; arthritis
Torus #
Buckle # distal radius, undisplaced; mechanically stable; POP 2-4/52
Smith’s #
# distal radius 1-2.5cm prox to wrist with volar
displacement and angulation (Reverse Colle’s); garden spade
deformity
MOI: fall on back of hand
Mng: traction in supination and wrist extension; above elbow POP
6/52; may need ORIF esp if adult
Barton’s #
Dorsal / volar rim # of distal radius extending
intraarticularily; dorsal rim more common; carpals usually
subluxed or dislocated with fragment in same direction; unstable as
ligamentous inj assoc; ORIF needed; can do closed reduction if <50%
jt surface involved and no carpal subluxation
Henderson
(Chauffeur’s)
#
Ulnar styloid
#
Radial styloid # from kickback; POP; most ligaments attach onto
radial styloid so can be carpal instability; ORIF if displaced / POP fails;
may be assoc with lunate dislocation, scapholunate dissociation,
trans-styloid perilunar dislocation, dorsal Barton’s #
Rarely significant; usually assoc with Colle’s
Notes from: