Document 6478866
Transcription
Document 6478866
GREENSTICK FRACTURE WITH DISLOCATION DISPLACEMENT OF P. The notice in Case 1-A purpose the of this R. paper OF THE UPPER END THE RADIO-HUMERAL OF THE WRIGHT, SUPERIOR an boy of four fracture displacement of ofthe fell the upper elbow Case and the to upper his right end of ofthe radius of the ulna Case 2-Greenstick fracture of the ulna girl of fracture displacement of the NO. injury of childhood which has received little 4, REPORTS arm, the injuring ulna (Fig. I). his with The elbow. Radiographs extension fracture showed deformity, was reduced and a forward by manipulation in plaster-of-Paris a full, painless range for five weeks. of movement of forearm. fracture 45 B, EPIPHYSIS ENGLAND and the arm was immobilised of the plaster he had regained 1-Greenstick Case 2-A greenstick VOL. on end under general anaesthesia Two weeks after removal the ULNA OR literature. CASE greenstick THE JOINT RADIAL MARGATE, is to describe OF with extension deformity the upper end of the radius. F... 2 with extension deformity the upper end of the radius. two fell from of the upper upper NOVEMBER end 1963 a chair, end of of the radius injuring the ulna (Fig. and forward displacement of and forward displacement of her left elbow. with extension 2). Manipulative Radiographs deformity, reduction and was showed forward a performed 727 P. 728 under general anaesthesia, Immobilisation plaster in plaster the Case child 3-A boy of of pain complained upper of end the was of the radius and ulnar but pronation 4-A plaster valgus. This normal but after and 3-Greenstick girl of without showed after deformity boy removal of the plaster is shown extension the ulnar nerve forearm the superior an injury to his upper radial left ofthe Recovery right valgus elbow. deformity reduction and of the immobilisation it became clear about 1 5 degrees of cubitus the elbow rapidly four radio-ulnar and was joint performed fixed elbow, had the upper end in view There of movement JOURNAL the but (Fig. of which ulna was with also 6). were valgus separation manipulation under The position on of the OF place details was by in plaster. of full, of supination. taken ofthe 5), (Fig. Eighteen almost at 45 degrees joint to months supination. remained that returned radiographs epiphysis. THE her with plaster epicondyle. Treatment weeks’ immobilisation 7. side). was extension being regained, the radio-ulnar fracture of the in Figure and injured Open superior pronation flexion a greenstick humeral by three the of After rapidly on the other fracture, Further range was of the displace- ulna 4). of limited. involved the of of there arm diagnosis reduction was and ulnar end the immobilisation. lateral the upper and correct 90 degrees of the (Fig. that and of absent, school end removal and injury sustained of the medial followed weeks’ He of the Open supination and school. at fracture of the with ofthe remained after at upper On fracture fusion and epiphysis decreasing showed steps Flexion ulnar were that a fracture-separation epiphysis anaesthesia incomplete tralispOsition of thirteen of the general weeks. was months pronation Radiographs and the by four manipulation three supination anterior suggested of radial with accepted. and Thirty and 5-A unknown. was later of the forearm. recognised success. compared of the and training first FIG. 3 of the ulna with varus deformity of the upper end of the radius. upper a gradually injury Radiographs Case for fracture that explained valgus. supination ulnar days without followed (70 degrees at accepted. removal elbow displacement Eight was after a greenstick not extension a flight the physical lateral was but and fracture together maintained and injury offiexion, down of out, doing position weeks of the showed attempted limited fell while this the Two movement radiographs out, range a greenstick position months carried incomplete weeks. manipulation. was fracture ment ten arm deformity slightly pronation cubitus and of therefore carried injury this right varus remained was his elbow, was three of painless extent a full of the range The removed Case was a full reduction fracture-separation reduction for with 3). showed epiphysis reduction injured ulna was was Radiographs and although maintained in plaster fracture plaster and in the manipulative the Case six WRIGHT was regained (Fig. immobilised made ill had R. BONE elbow AND and JOINT forearm SURGERY GREENSTICK FRACTURE OF THE UPPER FIG. Case 4-Greenstick fracture separation of the and involvement 4-Radiographs taken thirty superior VOL. 45 B, NO. 4, NOVEMBER 1963 valgus radial deformity and fracture- epiphysis. 5 reduction, radio-ulnar FIG. Case with of the upper after attempted of the superior 729 4 ulna FIG. Case 4-Radiographs END OF THE ULNA showing incomplete reduction joint by the ulnar fracture. 6 months radio-ulnar after injury joint. suggesting fusion of the 730 P. was slow loss of flexion. time it became of the united and four months after Pronation clear injury was that there limited traumatic Case WRIGHT was still 30 degrees to 20 degrees ulnar ulnar nerve was performed. and that involvement of the R. neuritis Further superior and was of extension and showed joint had after and 40 degrees to 70 degrees. developing radiographs radio-ulnar 5-Radiographs loss supination anterior that not At this transposition the ulnar occurred fracture (Fig. 8). had reduction. I rr., _# ,. L.’ I Case 5-Radiographs showing union of the superior of the ulnar radio-ulnar fracture joint. without involvement DISCUSSION Hume (1957) described three associated showed with anterior dislocation that in one of the cases fracture and the head in Case 3 above. Beddow and fracture of dislocation The of the literature It seems the clear ofthe was displaced (1960) the radio-humeral joint. does not contain any other matter what laterally, two with no of described ulna that, end of undisplaced fracture of the of the head of the radius. there was a varus deformity radius Corkery upper cases the cases varus reports direction similar of the in children to the displacement same deformity of this olecranon The radiographs in his paper of the ulna at the site of the type, was in which described a greenstick accompanied by lateral injury. of angulation of the ulna may ulna and the radius remain in a fixed relationship to one another while the injury place. Only in this way can the correspondence between the direction of angulation ulna and the direction of displacement of the upper end of the radius be explained. be, the is taking of the For the same reason it seems clear that this position must be one of full supination. The most probable mechanism therefore seems to be a fall on to the outstretched hand during which the forearm is held supinated (as it might be ifthe child were falling backwards). The direction of angulation THE JOURNAL OF BONE AND JOINT SURGERY GREENSTICK of the ulna varus, valgus will then or by be determined hyperextension (1957) Hume explained FRACTURE OF by the strain suggested that on UPPER exact the anterior a hyperextension THE direction forearm on the more group, likely in which ing the the injury the direction the that arm dur- the same, but is determined of the failure of the to injury Even when ment of the ulna may the radius is in the produce a while the head the radius by Evans however, of (1949) could might be position of in the production of the not apply to those cases may the true it is first the not (Cases which by reduction recognise when may fall, fall. it is recognised, manipulation 731 ULNA a ofthe Imperfect from form position Complications-l) by types is essentially direction nature three ofangulation exact result all THE 9). of ulna OF of the (Fig. displacement strain pronation-a mechanism similar to that described Monteggia fracture-dislocation. Such an explanation, with medial and lateral displacement. It seems END displace- be easy 2 and seen. to correct 4). 2) Trau- matic ulnar neuritis is a considerable danger in those cases with valgus deformity if reduction is imperfect. injury was not seen occurred of the in one displacement of the by and Beddow 3) this in Radial series patients radial with head Corkery the (1960). They it to be a neurapraxia traction by the displaced radial nerve supinator as muscle. through must to the occur to have the involved only ulnar 1’ GREENSTICK superior in all cases loss of movement case, in which the appeared resulting radius on it winds 4) Injury radio-ulnarjoint complete in one lateral described considered from nerve but it FRACTURE ULNA WITH VARUS but OF MONTEGGIA AND LATERAL DISPLACEMENT OF RADIAL HEAD occurred fracture F To illustrate the the joint. INJURY DEFORMITY 9 of mechanism Monteggia this injury and the injury. SUMMARY 1. Five cases of greenstick radio-humeral joint Although of the upper the end 2. cases form 3. The of the upper end of the ulna with dislocation of the are described. direction of angulation of the fracture and the of the radius may be lateral, medial or anterior, a group is considered fracture to be in which the mechanism ofinjury a fall the outstretched hand complications on of the I should like and CORKERY, injury to thank Mr are W. is essentially with the corresponding it is suggested the forearm same. held displacement that all five This mechanism in supination. described. A. Watt Maney for permission to include Case 5. REFERENCES F. BEDDOW, H., Fracture EVANS, HUME, VOL. E. of the Upper M. (1949): C. (1957): of the Olecranon A. 45 B, NO. 4, End Pronation (1960): of the Ulna. P. H. Injuries Anterior Dislocation in Children. Journal NOVEMBER 1963 of the Lateral Dislocation Journal of Bone Forearm. of the Head of Bone and of the Radio-humeral and Journal of the Joint Joint ofBone Radius Surgery, Surgery, andJoint Associated 39-B, 508. Joint 42-B, with Greenstick 782. Surgerv, with 31-B, Undisplaced 578. Fracture