Abstract
Diaphyseal fractures can be divided into three groups comprising the basic types of fractures: fractures of both bones (radius and ulna), fracture dislocations, i.e., fractures of one of the bones accompanied by dislocation of the head of the other bone in the respective radioulnar joint, the Galeazzi fracture or the Monteggia fracture, and isolated fractures of one of the two bones – the radius or the ulna.
Photographs are decisive for diagnosis of the anteroposterior and lateral projections. Each must simultaneously visualize the elbow and wrist joints in order not to neglect potential injuries located there.
The basic aim is full restoration of the function of the forearm with emphasis on supination-pronation movement. This requires anatomical union particularly in regard to the ulna, which has a critical importance for the function of the forearm. In fracture dislocations, it is also necessary to restore stability in the respective radioulnar joint.
For the above-mentioned reasons, almost all diaphyseal fractures (except for non-dislocated or minimally dislocated fractures of the ulna) are indicated for surgery. Our procedure depends on the condition of the fracture and the general condition of the patient.
Plate fixation represents the gold standard for closed fractures – open fractures of Degrees I and II and some Degree III fractures classified according to Tscherne. More extensive defects of soft tissues require cooperation with a plastic surgeon.
The standard implants are dynamic compression plates (3, 5 DCP) with holes for 3.5 mm cortical screws. The surgical approach to the ulna is relatively simple. In fractures of the proximal half of the radius, we prefer the Henry approach in fractures of the proximal half of the radius because, unlike the Thompson approach, it allows safe dissection up to the radial head without damaging the deep branch of the radial nerve. The main principle is a 3 + 3 fixation, meaning that the plate must be fixed to each of the two main fragments, minimally by three screws. An exception can be made in the vicinity of the joint when the fragment is too short to accommodate three screws.
The abstracts were prepared by David P. Davlin. Correspondence should be addressed to him at the Orthopedic Clinic Bulovka, Budínova 2, 18081 Prague 8, Czech Republic.
