Widening of the distal radioulnar joint space Radial head dislocation is often overlooked palpate radial head in the antecubital fossaĭistal to middle third of the radius, with dislocation of the radioulnar jointįall on an outstretched hand, with wrist extended and pronatedĪssess for wrist deformity, tenderness at the distal radioulnar joint Ulna fracture with dislocation of the radial head at the radiocapitellar jointįall on an outstretched hand, with elbow extended and forearm hyperpronatedĪssess radial nerve function, thumb extension Mason types III and IV fractures possibly type II fractures ( Table 3) Immobilization in posterior splint for 10 days, then transition to a plaster sleeve or functional brace for 4 to 6 weeksĪny concurrent injuries of the radius, distal radioulnar joint, or elbow joint comminution displacement that does not meet the criteria for conservative management Reduction, sugar-tong splint, posterior (ulnar gutter) splintĬonservative management if fracture is located in the middle or distal third of the diaphysis, displacement is < 50% of the bone diameter, and angulation is < 10 degrees
Reduction followed by a lateral radiograph to verify distal radioulnar joint alignment sugar-tong splintĬoncurrent dislocation, carpal fracture, ulnar styloid fracture, fracture instability/comminuted pattern, injury to radiocarpal or radioulnar ligaments, malunionĭistal radioulnar joint instability, associated intra-articular fractures, displacement, angulation, shortening, comminution, or rotation > 30 degrees of angulation or > 50% displacement Greenstick/complete distal radius in children 4, 5 Treatment of radial head fractures depends on the specific characteristics of the fracture using the Mason classification. Radial head fractures may be difficult to visualize on initial imaging but should be suspected when there are limitations of elbow extension and supination following trauma. Combined fractures involving both the ulna and radius generally require surgical correction. These fractures are treated with immobilization or surgery, depending on the degree of displacement and angulation. Isolated midshaft ulna (nightstick) fractures are often caused by a direct blow to the forearm. It should be noted that these fractures may be complicated by a median nerve injury. A nondisplaced, or minimally displaced, distal radius fracture is initially treated with a sugar-tong splint, followed by a short-arm cast for a minimum of three weeks. In adults, distal radius fractures are the most common forearm fractures and are typically caused by a fall onto an outstretched hand. Depending on the degree of angulation, buckle and greenstick fractures can be managed with immobilization. Greenstick fractures, which have cortical disruption, are also common in children.
Incomplete compression fractures without cortical disruption, called buckle (torus) fractures, are common in children. If initial imaging findings are negative and suspicion of fracture remains, splinting and repeat radiography in seven to 14 days should be performed. Evaluation with radiography or ultrasonography usually can confirm the diagnosis. A fall onto an outstretched hand is the most common mechanism of injury for fractures of the radius and ulna. Fractures of the radius and ulna are the most common fractures of the upper extremity, with distal fractures occurring more often than proximal fractures.
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