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Radius and Ulna Shaft Fracture ORIF 25574

forearm cross section picture

synonyms: forearm fracture ORIF, Radius and Ulnar Shaft Fracture ORIF, forearm fracture ORIF

Forearm Fracture ORIF CPT

Forearm Fracture ORIF Indications

  • Displaced forearm fracture in an adult

Forearm Fracture ORIF Contraindications

  • Active infection
  • Gross contamination
  • Severe soft tissue injury

Forearm Fracture ORIF Alternatives

  • External Fixation
  • Intramedullary nails
  • Casting

Forearm Fracture ORIF Pre-op Planning

Forearm Fracture ORIF Technique

  • Sign operative site.
  • Pre-operative antibiotics, +/- regional block.
  • Supine position. Hand table; tourniquet high on arm; all bony prominences well padded.
  • General endotracheal anesthesia
  • Prep and drape in standard sterile fashion. Arm exsagninated with Esmarch, tourniquet inflated
  • Radius= Henry volar approach. Distally develop plain between brachioradialis and FCR.
  • Ensure superficial sensory branch of radial nerve is preseved distally and PIN is preserved proximally.
  • Minimize periosteal stripping and soft tissue dissection as much as possible
  • Expose fracture, reduce and plate using standard AO technique. Generally 8-cortices above and below fracture. For purely transverse fractures 6-cortices (6 hole plate) is effective.
  • Consider dorsal Thompson approach for fx of the proximal 1/3 of the radius. Plane between EDC and ECRB. Elevate suppinator with forearm in supination to protect PIN
  • Ulnar fixation via straight dorsal approach along subcutaneous border of ulna. Place plate dorsal surface of ulna beneath the ECU
  • Irrigate.
  • Close in layers.

    Forearm Fracture ORIF Complications

    Forearm Fracture ORIF Follow-up care

    • Post-op: Volar plaster splint with sling. NWB. Active elbow and finger ROM.
    • 7-10 Days: Wound check, Place in funtional brace (interosseous mold). Begin active pronation/supination. Continue active elbow and finger ROM. Activity restrictions. Use for arm for light ADLS only. NWB.
    • 6 Weeks: Gradually resume normal activites provided bony union is evident on xrays.
    • 3 Months: Consider bone stimulatorif union is not evident on xray.
    • 6 Months: return to sports / full activities.
    • 1Yr: Follow-up xrays, assess outcomes.

    Forearm Fracture ORIF Outcomes

    • 12%nNonunion for comminuted, diaphyseal fractures of both bones of the forearm treated with dynamic compression plates. Union not related to bone grafting, ipsilateral injury, open fracture or multiple injuries (Ring D, J Trauma 2005;59:436).
    • Approximately 8 weeks to union, longer for comminuted fractures
    • Forearm fracture plate removal:  4%-22% Refracture risk following forearm plate removal.  Recommend waiting 12-18 months before plate removal. Cast or brace is worn for 6 weeks post-op; activities protected 3-4 months. Screw holes may remain stress risers for up to 4 months.  (Busam ML, J Am Acad Orthop Surg. 2006 Feb;14(2):113-20).

    Forearm Fx Review References

    Rockwood and Green's Fractures in Adults 6th ed, 2006

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