Module 54, General Orthopaedist Level

A 12 year old right hand dominant female presented to the emergency room complaining of right forearm pain. The patient stated that while playing basketball she fell down and another player subsequently fell onto her right arm. Physical exam revealed an alert white female. The volar surface of the proximal forearm had two small puncture wounds. Radiographs revealed a comminuted fracture of the proximal one-third of the ulna with over-riding of the fragments. The radial head was dislocated anteriorly.

Question 54A

In the operating room the puncture wounds should be opened and extensively irrigated.

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Question 54B

The first step in the reduction should be to reduce the radial head.

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Question 54C

Following appropriate wound care, this fracture can usually be closed reduced and immobilized in long arm cast.

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Question 54D

The radial head dislocation will require an open repair of the annular ligament as part of the open reduction.

FALSE: In acute treatment, repair or reconstruction of the annular ligament is seldomly needed. Accurate reduction of the fracture ususally causes the radial head reduction to be stable.

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Question 54E

The correct classification of this fracture is type II Monteggia lesion often caused by a fall on the outstrectched hand.

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