Book contents
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Chapter 1
- Chapter 2
- Chapter 3
- Section I Fractures of the proximal ulna
- Section II Fractures of the ulnar shaft
- Section III Fractures of the distal ulna
- Chapter 4
- Chapter 5
- Chapter 6
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Section II - Fractures of the ulnar shaft
from Chapter 3
Published online by Cambridge University Press: 05 February 2015
- Frontmatter
- Dedication
- Contents
- List of contributors
- Preface
- Acknowledgments
- Part I Upper extremity
- Chapter 1
- Chapter 2
- Chapter 3
- Section I Fractures of the proximal ulna
- Section II Fractures of the ulnar shaft
- Section III Fractures of the distal ulna
- Chapter 4
- Chapter 5
- Chapter 6
- Part II Pelvis and acetabulum
- Part III Lower extremity
- Part IV Spine
- Part V Tendon injuries
- Part VI Compartments
- References
- Index
Summary
OPEN REDUCTION AND INTERNAL FIXATION: PLATING
Indications
Displaced fractures of the middle third of the ulna in adults.
Monteggia fractures: fracture of the ulna shaft with fracture and/or dislocation of the proximal radius/radial head.
Fractures of both forearm bones.
Pre-operative planning
Clinical assessment
Mechanism of injury: Nightstick injury: direct blow; Monteggia fractures: axial compression; forearm fracture: any combination. Ensure adequate examination of the elbow and wrist joint for associated pathology.
Low- vs. high-energy injury, ensure no open fractures are missed with ulna wound volarly and covered by splint when first examined.
Arm at risk for compartment syndrome: document neurovascular status early and monitor changes.
In multiple-injured patients treatment sequence follows the ‘life-before-limb’ protocol.
Look for occult injuries in the rest of the arm, especially in the carpus/hand.
Radiological assessment
Rule of 2: 2 views, 2 joints (and 2 visits). Radiographs may be incomplete initially as pain/splints may interfere with the result.
Traction views in theatre may be necessary for valid pre-operative planning.
Operative treatment
Anaesthesia
Timing of surgery essential: in low-energy injuries this is notanissue whilst in high-energyoneswith displacement, shortening and/or dislocation, early intervention is preferable to avoid complications.
General anesthesia preferable. Avoid regional anesthetic/ blocks in acute injuries as they may mask symptoms indicating compartment syndrome in the immediate post-operative period.
Pre-operative administration of antibiotics and prescrub the limb.
Apply tourniquet if not contraindicated and inflate following elevation for 3 minutes once limb prepped and draped.
- Type
- Chapter
- Information
- Practical Procedures in Orthopaedic Trauma Surgery , pp. 51 - 55Publisher: Cambridge University PressPrint publication year: 2006