Presentation
Right forearm pain and deformity after attempting a back handspring
Patient Data
There are oblique complete fractures of the right radial and ulnar mid diaphysis. There is one shaft width of ulnar and volar displacement of the radial fracture. There is one shaft width of ulnar and dorsal displacement of the ulnar fracture. There is mild overlap/foreshortening as well as dorsal angulation of both fractures. There is 90 degrees of rotation of both fractures - the elbow and wrist joints are oriented perpendicular to each other in this case.
In addition, the following rules are not met:
the bicipital tuberosity and radial styloid should normally be 180 degrees apart on the AP view.
the ulnar styloid and coronoid should normally be 180 degrees apart on the lateral view.
Plate and screw fixation of the radial and ulnar diaphyseal fractures. There is improved, anatomic alignment of the fractures. There is bridging callus across the fractures with obscuration of the fracture lines, consistent with healing.
The previously seen rotational abnormality has been reduced and the following rules are met:
the bicipital tuberosity and radial styloid should normally be 180 degrees apart on the AP view.
the ulnar styloid and coronoid should normally be 180 degrees apart on the lateral view.
Case Discussion
While displacement, distraction/impaction, and angulation of a fracture are often easily recognized, rotational malalignment can be difficult to perceive. Looking at the relative alignment of the two joints adjacent to the fracture is helpful. For both bone forearm fractures, it is also critical to check that the rules mentioned above are met. Failure to recognize and reduce the rotational malalignment can lead to functional impairment.
In this case, the patient had both bone forearm fractures at the same level with oblique orientation and converging fragments (on the lateral view), all three of which are signs of instability. There is also bayonet apposition of each fracture i.e. the two bone fragments are aligned side-by-side rather than in end-to-end contact.
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