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Radius and Ulnar Shaft Fractures
Posted: Aug 24 2019 #(C101255)
A

Open Both Bone Forearm Fracture in a 44F

HPI

Patient presented to the ED with chief complaint of left forearm pain following a bicycle accident. Patient denies additional injuries. Patient denied motor or sensory deficit.

PMH

HTN, GERD History of breast reduction surgery Denied alcohol, tobacco, or illicit substance use

PE

Patient is alert and oriented in the ED with pain to palpation of the left forearm. She has a 1cm x 1cm open wound over the ulna. She is neurovascularly intact. Remainder of the exam is unremarkable

Poll
1 of 10
1. According to the Gustilo classification, how would you classify this open fracture?
Type I
41%
880/2122
Type II
27%
582/2122
Type III
5%
108/2122
Type IIIa
20%
427/2122
Type IIIb
4%
86/2122
Type IIIc
1%
39/2122
2. What antibiotics would you put this patient on for the open fracture?
Ancef alone
58%
1204/2055
Ancef + Vancomycin
5%
115/2055
Ancef + Gentamicin
29%
596/2055
Ancef + Penicillin
3%
77/2055
Vancomycin alone
0%
17/2055
Other
2%
46/2055
3. In addition to I&D, how would you treat this fracture?
ORIF without bone grafting
81%
1650/2027
ORIF with bone grafting
6%
128/2027
External Fixation
7%
152/2027
IM Nailing
4%
94/2027
Functional bracing
0%
3/2027
4. Considering the open wound over the ulnar, when performing ORIF would you perform fixation of the ulnar or radius first?
Ulna
60%
1189/1967
Radius
38%
756/1967
I would not perform ORIF
1%
22/1967
5. If performing ORIF, what surgical approach(s) would you use to address this injury?
Single Volar (Henry) approach for both Ulna and Radius
5%
104/1841
Single Dorsal (Thompson) approach for both Ulna and Radius
3%
63/1841
Volar (Henry) approach for Radius, separate incision for Ulna (over Ulna, between ECU and FCU)
75%
1381/1841
Dorsal (Thompson) approach for radius, separate incision for Ulna (over Ulna, between ECU and FCU)
14%
271/1841
I would not perform ORIF
1%
22/1841
6. What type of fixation you use to address the segmental radial shaft Fx?
Single plate
57%
1046/1825
Combination of mini fragment plates and a long plate to span both segments
22%
409/1825
Two separate plates to address each segment
13%
252/1825
Intramedullary rod
5%
109/1825
Other
0%
9/1825
7. What type of plate fixation would you use for the Ulna Fx?
Small frag dcp
48%
849/1757
2.7 mm dcp
25%
455/1757
Minifrag dcp
3%
60/1757
Recon plate
8%
157/1757
1/3 Semitubular plate
12%
214/1757
I would not plate the ulna
1%
22/1757
8. If performing bone grafting, what would you use?
Cancellous Allograft Chips
12%
212/1716
Fibula Allograft
1%
21/1716
Autogenous Cancellous Graft
18%
311/1716
Autogenous Vascularized Fibular Graft
0%
16/1716
I would not perform bone grafting
67%
1156/1716
9. What is your post operative dressing?
Sugartong splint
37%
636/1713
Short arm splint
18%
323/1713
Soft dressing
22%
389/1713
Cast
13%
235/1713
Forearm brace
7%
130/1713
10. What is your immediate range of motion and weight bearing protocol post-operatively?
ROM as tolerated, WBAT
11%
190/1667
ROM as tolerated, NWB
46%
777/1667
Protected ROM, WBAT
9%
158/1667
Protected ROM, NWB
32%
542/1667
PROCEDURE #1

Irrigation and debridement of left forearm wound with open reduction internal fixation of both bone forearm fracture

Intra-procedure P1
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