Unstable Fracture-Dislocations of the Forearm

Abstract

FRACTURE-dislocations of the forearm are not common injuries. They are inherently unstable due to a variety of factors which are poorly understood by many surgeons. Mistakes in their management account for a high incidence of poor results. In fractures of the forearm, any shortening of one bone of the forearm necessitates either a fracture of the other with equivalent shortening, or a dislocation at the proximal or distal radio-ulnar joint (Fig 1). The proximal and distal joints must be carefully scrutinized in every fracture of the forearm. When the ulna is fractured and shortened, the proximal radio-ulnar joint dislocates (the Monteggia fracture). When the opposite occurs (that is, the radius breaks and shortens), the distal radio-ulnar joint dislocates, resulting in the Galeazzi or "reverse Monteggia" fracture. Reduction of these fracture-dislocations must be accurate and must be maintained until healing is complete, or there will be encroachment on the interosseous membranes