OR2.5-6 | Forearm Fracture Patterns — Summary & Reflection

KEY TAKEAWAYS

The forearm functions as a two-bone kinematic unit; fractures of one bone alter the other bone's joints. Monteggia = proximal ulna fracture + radial head dislocation at the elbow (PRUJ); the mnemonic is 'Monteggia -- Medial ulna -- Missing radial head in the elbow.' Galeazzi = distal radius fracture + DRUJ disruption at the wrist; 'Galeazzi -- distal radius -- Gone DRUJ.' Both require ORIF in adults. Both-bones forearm fractures in adults require dual-plate fixation. Distal radius fractures: Colles = dorsal angulation (dinner-fork deformity); Smith = volar angulation; Barton = articular rim shear. Management ranges from plaster for stable undisplaced fractures to volar locking plate for displaced or articular patterns. Complications to monitor: compartment syndrome (forearm pain, passive finger stretch pain, paraesthesia), median nerve compression (acute carpal tunnel), and missed DRUJ/PRUJ disruption.

REFLECT

A 35-year-old carpenter presents 6 weeks after a fall with persistent wrist pain, restricted forearm rotation, and a lateral wrist radiograph showing the ulnar head is chronically dorsally subluxed at the DRUJ. He was treated elsewhere with a plaster cast for a 'distal radius fracture.' What likely injury was missed at the time, what is the probable diagnosis now, and what are the challenges of managing a chronic Galeazzi injury compared to an acute one? Reflect on how this case illustrates the importance of routinely imaging both joints in forearm fractures.