Executive Editor: Peter Trafton, Michael Baumgaertner

Authors: Peter Kloen, David Ring

Proximal forearm

back to skeleton

Glossary

Radius, extraarticular, avulsion of bicipital tuberosity

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative Patients who tolerate 40% loss of supination strength. Nondisplaced fractures. Basic surgical experience, no specialized skills Basic equipment only
Biceps reinsertion Displaced fracture and desire for optimal supination strength Highly experienced and skilled surgeon Simple surgical and imaging resources

Radius, extraarticular, simple

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative Non- or minimally displaced stable fracture Basic surgical experience, no specialized skills Basic equipment only
Compression with T-plate and screws Displaced transverse fracture Highly experienced and skilled surgeon Simple surgical and imaging resources

Radius, extraarticular, multifragmentary

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative Well aligned elbow and likely to remain so Basic surgical experience, no specialized skills Basic equipment only
Radial head arthroplasty Irreparable radial head and neck Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plate Displaced or unstable fracture when stable fixation is possible Highly experienced and skilled surgeon Simple surgical and imaging resources

Radius, partial articular

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative Non- or minimally displaced fractures with no restriction of forearm rotation Basic surgical experience, no specialized skills Basic equipment only
Lag screw Simple displaced fractures Highly experienced and skilled surgeon Simple surgical and imaging resources
Radial head excision Isolated unreconstructable radial head fracture with stable elbow but limited forearm rotation. Intact interosseous membrane and distal radioulnar joint (DRUJ). Some specialized surgical experience Basic equipment only
Radial head arthroplasty Inability to reconstruct radial head fracture so that it provides sufficient stability for elbow joint. Interosseous membrane injury (Essex-Lopresti injury). Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Radius, complete articular

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative Undisplaced or minimally displaced fractures with acceptable supination and pronation range. Immobilization desired. Basic surgical experience, no specialized skills Basic equipment only
Plate and screws Reconstructable multifragmentary fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Radial head excision Isolated unreconstructable radial head fracture with stable elbow but limited forearm rotation. Intact interosseous membrane and distal radioulnar joint (DRUJ). Some specialized surgical experience Simple surgical and imaging resources
Radial head arthroplasty Inability to reconstruct radial head fracture so that it provides sufficient stability for elbow joint Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Ulna, extraarticular, avulsion of triceps insertion

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative Minimal displacement (< 2 mm). Active elbow extension. Immobilization unnecessary. Basic surgical experience, no specialized skills Basic equipment only
Tricepts reinsertion Triceps avulsion with unacceptable weakness Some specialized surgical experience Basic equipment only

Ulna, extraarticular, simple

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative Minimally displaced, stable fracture Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixation Significant soft-tissue injury or contamination Some specialized surgical experience Simple surgical and imaging resources
Compression plate Displaced transverse fracture Some specialized surgical experience Simple surgical and imaging resources
Compression plate and lag screw Oblique fracture suitable for compression with both lag screw and plate Some specialized surgical experience Simple surgical and imaging resources
Lag screw and protection plate Oblique fracture. Interfragmentary compression by lag screw, but not plate. Some specialized surgical experience Simple surgical and imaging resources

Ulna, extraarticular, multifragmentary

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative Nondisplaced, stable fracture Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixation Significant soft-tissue injury or contamination Some specialized surgical experience Simple surgical and imaging resources
Bridge plate Unstable, displaced fracture Highly experienced and skilled surgeon Simple surgical and imaging resources

Ulna, articular, olecranon

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative Undisplaced fractures Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixation Extensive soft-tissue damage Some specialized surgical experience Simple surgical and imaging resources
Tension band wiring Transverse simple fracture of the olecranon Some specialized surgical experience Basic equipment only
Bridge plate Multifragmentary fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Lag screw with neutralization plate Oblique simple fracture of the olecranon Some specialized surgical experience Simple surgical and imaging resources

Ulna, articular, coronoid

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative Well aligned joint on 3DCT and reliability patient Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixation Extensive soft-tissue damage Some specialized surgical experience Simple surgical and imaging resources
Repair of coronoid fracture Coronoid fracture with elbow subluxation Highly experienced and skilled surgeon Simple surgical and imaging resources

Ulna, complete articular

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative Well aligned joint on 3DCT and reliability patient Basic surgical experience, no specialized skills Basic equipment only
Temporary external fixation Extensive soft-tissue damage Some specialized surgical experience Simple surgical and imaging resources
Bridge plate Bridge plating is required to maintain anatomic articular congruence Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Varus posteromedial rotational instability

Please select a treatment option:
Treatment Indication summary Skill Equipment
Open reduction internal fixation Anteromedial coronoid facet fracture and lateral collateral ligament avulsion or olecranon fracture with subluxation of the elbow Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Hinged external fixation following ORIF Comminuted coronoid fracture that needs protection or when coronoid repair does not provide sufficient elbow stability Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Terrible triad

Please select a treatment option:
Treatment Indication summary Skill Equipment
Open reduction internal fixation Posterior dislocation with fractures of the radial head and coronoid and residual subluxation or recurrent dislocation after reduction Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Hinged external fixation following ORIF Residual subluxation or repeat dislocation after open repair Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Anterior fracture dislocation

Please select a treatment option:
Treatment Indication summary Skill Equipment
Open reduction internal fixation Most anterior transolecranon fracture-dislocations benefit from plate and screw fixation Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Hinged external fixation following ORIF ORIF does not provide sufficient elbow stability Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Posterior fracture dislocation

Please select a treatment option:
Treatment Indication summary Skill Equipment
Open reduction internal fixation Most posterior olecranon fracture dislocations benefit from plate and screw fixation Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Hinged external fixation following ORIF ORIF does not provide sufficient elbow stability Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Special considerations
Principles of management of open fractures
Infection
Compartment syndrome
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v2.0 2018-04-30