orthopaedic basic trauma

1. DEPARTMENT OF ORTHOPAEDICS
BMC SAGAR
• PRESENTED BY -
• DR MAYANK SHROTRIYA
• MODERATOR-
• DR GAURAV AGARWAL
• DR PROF. RAJESH JAIN
SIR
(HEAD OF DEPARTMENT
OF ORTHOPAEDICS)

2. FRACTURE SHAFT OF RADIUS ULNA

3. INTRODUCTION
• Includes fracture of RADIUS OR ULNAR DIAPHYSIS OR
BOTH.
• HIGH ENERGY TRAUMA
• MAY BE MORE COMMON IN MEN.

4. EPIDEMIOLOGY
• IN AO documentation 1980-1996,10-14% of fracture
recorded occur in FOREARM.
• FROM 1996-2006,MORE than 200% increase in the
volume of surgically treated FOREARM fractures.

5. SPECIAL CHARACTERSTICS
• Forearm fractures associated with JOINT
DISLOCATIONS either in the PROXIMAL or DISTAL
ASPECT of the fore arm
• High Rate of delayed union or non union despite usually
being closed injury with simple fracture pattern.

7. ANATOMY
• Ulna is relativlely straight bone WHICH IS
POSTERIOMEDIALLY POSITIONED
• two bones are bond proximally by the capsule of
elbow joint and annular ligament and distally by dorsal,
volar radioulnar ligaments and TFCC.
• interosseous space is greater distally due lateral curve
of radius.
• central portion of interosseous memberane is 2.5cm
thick and accounts for most of the longitudinal support
of radius.

8. RADIAL BOW

9. RADIAL BOW
• ALLOWS INCREASED RANGE OF PRONATION.
• RADIUS ROTATES OVER AXIS BETWEEN PROXIMAL
AND DISTAL RADIOULNAR JOINTS
• IN SUPINATION BOWING TIGHTENS OBLIQUE AND
INTEROSSEOUS LIGAMENTS INCREASING
PROXIMAL RADIOULNAR STABILITY.

10. ANATOMY
• Studies shown that incison of central band of
interosseous membreane reduce STABILITY BY 74% IN
COMPARISION TO INCISON OF TFFC WHICH
REDUCE 11% STABILITY.
• Radius ulna mainly joined by 3 muscles: 1. supinator
• 2.pronator
teres
• 3.pronator
quadratus.

11. LIGAMENTS
1. ANNULAR LIGAMENT--
• PRIMARY STABILIZER OF PROXIMAL RADIO ULNAR
JOINT.
• MAINTAIN THE RADIAL HEAD IN RADIOULNAR
NOTCH THROUGHOUT THE RANGE OF MOTION
2.QUADRATE LIGAMENT(LIGAMENT OF DENUCE)
STABILIZE RADIAL HEAD IN ROTATION
3.OBLIQUE LIGAMENT(LIGAMENT OF WEITBRECHT)

12. LIGAMENTS

13. TRIANGULAR FIBROCARTILAGE COMPLEX
• SHARES THE LOAD AND STRESS TO ABOUT 20-30%
produced AXIAL COMPRESSION.
• MAINTAINS THE STABILITY OF DRUJ FOR SMOOTH
ROTATION OF FOREARM.
• DISTAL CONNECTION SUSPENDS THE ULNAR SIDE
OF CARPUS WITH ULNA WHICH IS NEEDED FOR
ADEQUATE GRIP STRENGTH.

14. TRIANGULAR FIBROCARTILAGE COMPLEX

15. INTEROSSEOUS MEMBRANE
• JOINS radius and ulna.
• STABILIZE RADIOULNAR JOINT.
• Comprises of:
1. PROXIMAL OBLIQUE CORD.
2. DORSAL OBLIQUE ACCESSORY CORD
3. CENTRAL BAND
4. ACCESSORY BAND
5. DISTAL OBLIQUE BUNDLE

17. ANTERIOR COMPARTMENT

18. ANTERIOR COMPARTMENT

19. ANTERIOR COMPARTMENT

20. POSTERIOR COMPARTMENT

21. POSTERIOR COMPARTMENT

22. IMAGING

23. IMAGING
• MILCH anatomic criteria criteria to determine alignment of
forearm bones:
1. CORONOID PROCESS OF ULNA POINTS
ANTERIORLY AND STYLOID PROCESS POINTS
POSTERIORLY IN LATERAL PROJECTION.
2. RADIAL STYLOID IS NOT SEEN IN NORMAL LATERAL
PROJECTION WITH FOREARM SUPINATED.
3. 3. IN NORMAL AP VIEW CORONOID AND STYLOID
PROCESS OF ULNA ARE HIDDEN BUT RADIAL
STYLOID AND BICIPTAL TUBEROSITY SEEN.

24. IMAGING
• MACLAUGHLIN’S LINE:
• A LINE DRAWN THROUGH RADIAL SHAFT,NECK AND
HEAD SHOULD PASS THROUGH THE CENTRE OF
THE CAPITULLUM ON ANY RADIOGRAPHIC VIEW OF
ELBOW.

25. MACLAUGHLIN’S LINE

26. EVANS VIEW
• BICIPITAL TUBEROSITY VIEW.
• X RAY TUBE TILTED 20 DEGREE TOWARDS
OLECRANON WITH SUBCUTANEOUS BORDER OF
ULNA FLAT ON CASSETTE.

27. EVALUATION AND DIAGNOSIS
• CASE HISTORY AND PHYSICAL EXAMINATION
1. MODE OF TRAUMA
2. SYMPTOMS
3. PHYSICAL EXAMINATION

28. MODE OF TRAUMA
• DIRECT
• INDIRECT
• MOST COMMON IS INDIRECT FORCE SUCH AS
LANDING ON OUTSTRECHED UPPER EXTERIMITY.
• RADIUS USUALLY FOLLOWED BY ULNA.
• IN YOUNGER CHILDREN SHAFT FRACTURE MORE
COMMON BECAUSE CORTICAL BONE IS MORE
POROUS AND TRANSITION FROM METAPHYSIS TO
DIAPHYSIS IS LESS DISTINCT THAN OLDER
CHILDREN.

29. EXAMINATION
• SWELLING
• TENDERNESS
• DEFORMITY OF FOREARM AT PROXIMAL AND DISTAL
JOINT DISLOCATION
• DECREASED FOREARM AND ELBOW MOTION.

30. AO/OTA FRACTURE AND DISLOCATION
CLASSIFICATION

31. CLOSED MANAGEMENT
• GREEN STICK VS COMPLETE FRACTURES.
• EVEN WITH MINIMALLY ANGULATED GREENSTICK
FRACTURES,ELBOW SHOULD BE EVALUATED
CAREFULLY TO RULEOUT MONTEGGIA TYPE 4.

32. CLOSED MANAGEMENT
• SHOULD GREENSTICK FRACTURES BE MADE
COMPLETE?
• FAVOUR: Angulation will reccur if it is not done.
• resorption zone developed on broken side of cortex
leading to refracture in future.
• AGAINST:chances of rotational deformity increases.

33. CLOSED MANAGEMENT
• IF BOTH BONE FRACTURES ARE COMPLETE THEN
MUSCLE PULL ON THE FRAGMENTS BECOMES
IMPORTANT SO ROTATION OF PROXIMAL
FRAGMENT IS DETERMINED AND DISTAL FRAGMENT
IS PLACED IN SAME ROTATION.
• MANUAL CLOSED REDUCTION
• TRACTION THROUGH FINGERTRAPS

34. ACCEPTABLE LIMIT OF ALIGNMENT

35. AFTERCARE
• DISTAL NEUROVASCULAR STATUS
• LIMB ELEVATION
• IMMEDIATE POSTOP XRAY FOLLOWED BY SERIAL
IMAGING AT 1,2,3 WEEKS AFTER REDUCTION.
• SLING APPLIED PROXIMALLY TO FRACTURE.

36. SURGICAL INDICATIONS
• DISPLACED FRACTURES OF BOTH THE RADIAL
AND ULNAR SHAFT IN ADULTS.
• DISPLACED,ROTATED (10 DEGREE) OR
ANGULATED(>10 DEGREE) isolated fracture of either
bone
MONTEGGIA,GALEAZZI AND ESSEX LOPRESTI TYPE
FRACTURE DISLOCATIONS.
OPEN FRACTURES

37. TIMING OF SURGERY
• IDEALLY CLOSED FOREARM FRACTURES BEST
OPERATED WITH IN FIRST 24 HOURS OF INJURY.
• PROLONGED DELAY MAY INCREASE THE RISK OF
RADIOULNAR SYNOSTOSIS.
• OPEN FRACTURES SHOULD UNDERGO
DEBRIDEMENT AND IRRIGATION AND FIXATION

38. IMPLANT SELECTION
• 3.5 MM DCP, LC DCP IS THE IDEAL SIZE
• LIMITED CONTACT DYANMIC COMPRESSION PLATE
IS RECOMMENDED.
• WHEREVER POSSIBLE AN INTERFRAGMENTARY
LAG SCREW INSERTED INDEPENDENTLY OR
THROUGH A PLATE HOLE. 3.5,2.7 OR 2.4mm CORTEX
SCREWS .
• FOR MOST FOREARM FRACTURES NON LOCKING
SCREW GIVE GOOD RESULT.

39. IMPLANT SELECTION

40. IMPLANT SELECTION

41. IMPLANT SELECTION
• ROLE OF INTERMEDULLARY NAILS--- STILL TO BE
DEFINED AS QUESTION PERSIST ON THEIR ABLITY
TO CONTROL ROTATION.
• ELASTIC NAILS GIVE ECELLENT RESULT IN
PEDIATRIC FOREARM FRACTURES.
• BUT THIS MODE OF FIXATION DOES NOT GIVE
ADEQUATE STABILITY FOR EARLY RANGE OF
MOTION IN ADULTS.

42. IMPLANT SELECTION
• SAGE NAIL ADRESSED THE ISSUE OF RADIAL
BOW,ALLOWING IMPROVED MOTION AND
DECREASE RATE OF NON UNION.
• FORESIGHT NAIL THAT CAN BE CONTOURED TO
RECREATE THE RADIAL BOW.
• DESPITE OF SATISFACTORY OUTCOMES,PLATE
FIXATION REMAIN SUPERIOR.
• WE RESEVRVE INTERMEDULLARY NAILING OPTION
WHERE SOFT TISSUE LOSS IS EXTENSIVE.

43. OPERATING ROOM SETUP AND POSITION

44. SURGICAL APPROACHES
• ULNA---- STRAIGHT INCISON ALONG
SUBCUTANEOUS BORDER.
• PLATE IS PLACED ON THE POSTERIOLATERAL
(EXTENSOR) OR ANTERIOR(FLEXOR) ASPECT OF
BONE.
• RADIUS--ENTIRE DIAPHYSIS: HENARY APPROACH
• MODIFIED HENARY
APPROACH
• RADIUS----PROXIMAL AND MIDDLE THIRD OF
DIAPHYSIS

45. SURGICAL APPROACHES
• AS A RULE, A SEPRATE INCISON FOR EACH BONE
SHOULD BE USED,PRESERVING A BROAD SKIN
BRIDGE BETWEEN THE TWO INCISIONS.
• ATETEMPTING TO FIX BOTH BONES THROUGH
SINGLE APPROACH INCREASES THE RISK OF
NERVE INJURY AND RADIOULNAR SYNOSTOSIS.

46. ULNAR APPROACH

47. VOLAR APPROACH

48. VOLAR APPROACH

49. DORSAL APPROACH

51. FIXATION
• REDUCTION IS FIRST PERFOMED ON THE BONE
WITH SIMPLER FRACTURE.
• PUSH PULL TECHNIQUE
• SLIGHT PREBENDING PREVENT FRACTURE GAP
OPPOSITE TO THE PLATE
• IF BONE GRAFT IS NECESSARY IT SHOULD BE
PLACED AW
• AY FROM INTEROSSUS MEMBERANE.

53. AFTERCARE
• A VOLAR SPLINT FOR FIRST WEEK TO REDUCE PAIN
OR EVEN LONGER IN UNRELIABLE PATIENTS.
• EARLY ACTIVE MOTION OF THE FINGERS
,WRIST,ELBOW TO AVOID COMPLEX REGIONAL PAIN
SYNDROME.
• WEIGHT BEARING USUALLY ALLOWED 6-8 WEEKS
AFTER SURGERY.
• RADIOGRAPHIC IMAGES TAKEN AT 6 AND 12 WEEKS
POSTOPERATIVLEY.

54. MONTEGGIA FRACTURE
• “SHAFT FRATURE OF ULNA WITH AN ANTERIOR OR
LATERAL DISLOCATION OF RADIAL HEAD AT THE
PROXIMAL RADIOULNAR JOINT”.
• according to watson-jones no fracture present so many
problems,no injury is beset with greater difficulty,no
treatment is characterized by more general failure.
• can be treated conservativley in children.

55. MECHANISM OF INJURY
• FOR TYPE 1
1. DIRECT BLOWS TO ULNAR ASPECT(SPEED AND
BOYD)
2. HYPERPRONATION THEORY(EVANS).
• HYPEREXTENSION THEORY
• FOR TYPE 2
1. PENROSE THEORY-forearm loaded inlongitudnal
direction with elbow bent 60*
• FOR TYPE 3
1. MULLICK THEORY OF VARUS STRESS

56. MECHANISM OF INJURY

57. BADO’S CLASSIFICATION
• TYPE 1: FRACTURE OF MIDDLE OR PROXIMAL THIRD
ULNA WITH ANTERIOR DISLOCATION OF RADIAL
HEAD AND APEX ANTERIOR ANGULATION OF ULNA.
• TYPE2: FRACTURE OF MIDDLE OR PROXIMAL THIRD
ULNA WITH WITH POSTERIOR DISLOCATION OF
RADIAL HEAD AN D OFTEN FRACTURE OF RADIAL
HEAD AND APEX DORSAL ANGULATION OF ULNA.

58. BADO’S CLASSIFICATION
• TYPE 3: FRACTURE OF ULNA JUST DISTAL TO
CORONOID PROCESS WITH LATERAL DISLOCATION
OF RADIAL HEAD.
• TYPE 4: FRACTURE OF PROXIMAL OR MIDDLE THIRD
ULNA,ANTERIOR DISLOCATION OF RADIAL HEAD
AND FRACTURE OF PROXIMAL THIRD RADIUS
BELOW THE BICIPITAL TUBEROSITY.
• TYPE 1 IS FAR EXCEEDS ALL OTHER IN FREQUENCY.
• ALTOUGH CHILDREN’ INJURIES INCLUDED IN MOST
SERIES.

59. BADO’S CLASSIFICATION

63. MANAGEMENT
• BOYD AND BOALS recommended RIGID INTERNAL
FIXATION of fractured ULNA either with compression
plate or a medullary nail and closed reduction of RaDIAL
HEAD.
• RING AND JUPITER recommended good results with
RADIAL HEAD REPLACEMENT FOR COMMUNITED
RADIAL HEAD FRACTURE.
• RYENDERS et al. recognized that early resection of head
as contributing to delayed union or non union of the ulnar
fracture by allowing INCREASED ANGULAR FORCES.

64. MANAGEMENT
• ANATOMIC OPEN REDUCTON AND INTERNAL
FIXATION OF ULNA WITH STABLE FIXATION ALMOST
ALWAYS ALLOW CLOSED REDUCTION OF RADIAL
HEAD.
• CONTINUED RADIOCAPITELLAR INSTABILITY most
frequently caused by MALREDUCTION OF ULNA.
• An APEX DORSAL MALREDUCTION can force the radial
head posteriorly.
• jupiter and kellam recommended a DORSAL PLATE in
this situation.

65. MANAGEMENT
• UNCONTOURED PLATE will malreduced the fracture
and prevent radial head from remaining reduced.
• IN a series of 121 patients MARYLAND SHOCK
TRAUMA report noted:
• IN 17% patients radial head was not reduced and
ANNULAR LIGAMENT ENTRAPTMENT was the cause.

66. MONTEGGIA EQUIVALENTS
• ISOLATED DISLOCATION OF RADIAL HEAD.
• RADIAL NECK FRACTURE ISOLATED
• RADIAL NECK FRACTURE IN COMBINATION WITH
FRACTURE OF ULNAR DIAPHYSIS.
• POSTERIOR DISLOCATION OF ELBOW
• ULNAR FRACTURE WITH DISPLACED FRACTURE OF
LATERAL CONDYLE.

67. GALEAZZI FRACTURE
• “
• FRACTURE OF RADIAL SHAFT WITH DISLOCATION
OF THE DISTAL RADIOULNAR JOINT”

68. • MECHANISM OF INJURY
• WHETHER THE DIRECT OR INDIRECT --- RADIAL
FRACTURE OCCURS FIRST FOLLOWED BY
DISRUPTION OF DRUJ.
• COMBINATION OF AXIAL LOADING AND AXIAL
ROTATION.
• DISLOCATION IS THE RESULT OF COMBINATION
AXIAL LOADING AND HYPERPRONATION OF WRIST.
• IN ELDER ,FRACTURE OCCUR AT HEIGHT OF
MAXIMAL RADIAL BOWING
• AND DISTAL FOREARM PIVOTS THE FRACTURE SITE

69. MECHANISM OF INJURY
• RADIAL FRACTURE is made more unstable by following
5 factors
1. pronator quadratus-rotates distal fragment
ULNAR,VOLAR AND PROXIMAL DIRECTION.
2. ABDUCTOR POLLICIS LONGOUS AND EXTENSOR
POLLICIS LONGUS-----RESPONSIBLE FOR
RELAXATION OF RADIAL COLLATERAL LIGAMENTS
AND RADIAL SHORTENING AND DISPLACEMENT OF

70. MECHANISM OF INJURY
3.BRACHIORADIALIS--UTILIZE DRUJ AS A POINT TO
ROTATE DISTAL FRAGMENT .
4. INTEROSSEOUS MEMBERANE:ATTACHED TO
DISTAL FRAFMENT OF RADIUS AND PREVENT RADIAL
SHORTENING.
• RADIAL SHORTENING >5MM ASSOCIATED
ASSOCIATED WITH TFCC TEAR.
• RADIAL SHORTENING > 10 MM ASSOCIATED WITH
SIGNIFCANT TEAR OF INTEROSSEOUS

71. CLINICAL PRESENTATION

75. GALEAZZI EQUIVALENT IN CHILDREN
1.
• WHERE RADIAL FRACTURES AT ABOUT 6-8CM
PROXIMAL TO WRIST WITH DISTAL ULNAR
EPIPHYSEAL SEPRATION
• OCCUR BEACAUSE EPIPHYSEAL PLATE OF DISTAL
ULNA IS WEAKER THAN TFCC.
• HENCE NO SUBLUXATION AND DISLOCATION OF
DRUJ.

76. GALEAZZI EQUIVALENT IN ELDER
• RADIAL SHAFT FRACTURES AT ABOUT 6-8CM
PROXIMAL TO WRIST ASSOCIATED WITH ULNAR
FRACTURE 2CM PROXIMAL TO WRIST.
• DUE WEAKER OSTEOPOROTIC ULNA THAN THE
ARTICULAR DISC OF TFCC.

77. IMAGING

78. IMAGING
• 4 RADIOLOGICAL CARDINAL SIGNS:
1. RADIAL FRACTURE BETWEN INSERTION OF
PRONATOR TERES AND PRONATOR QUADRATUS
ASSOCIATED WITH RADIAL SHORTENING OF > 5
MM.
2. 2.FRACTURE STYLOID PROCESS OF ULNA WHICH
IS STRUCTURAL EQUIVQLENT OF TEAR IN TFCC.
3. WIDENING OF LOWER END OF RADIUS AND ULNA
I.e DIASTASIS.
4. DORSAL DISPLACEMENT OF DISTAL ULNA IN

80. ESSEX-LOPRESTI LESION
• “PROXIMAL RADIAL SHAFT OR RADIAL NECK/ HEAD
FRACTURE COMBINED WITH IN STABILITY OF DRUJ”
• PROXIMAL MIGRATION OF THE RADIUS TEARS THE
INTEROSSEOUS MEMBERANE AND CAUSES AXIAL
INSTABILITY.
• FAILURE TO ADRESS RADIOULNAR INSTABILITY AT
ONSET CAN RESULT IN PERSISTENT AXIAL
MIGRATION OF RADIUS.
• SO DIFFICULT TO TREAT IN LATE STAGE.
• ORIF OF PROXIMAL RADIAL FRACTURE AND

83. NIGHT STICK FRACTURES
• “ISOLATED FRACTURE OF ULNA WITHOUT RADIAL
HEAD INSTABILITY”
• CLASSIFIED AS :
1. UNDISPLACED SIMPLE FRACTURE
2. DISPLACED MORE THAN 50% OF DIAMETER OF
DIAPHYSIS,ANGULATED> 10*
3. UNUSAL FRACTURES

84. MANAGEMENT
• ISOLATED DIAPHYSEAL FRACTURE WITH
DISRUPTION MORE THAN 50%-- ORIF WITH 3.5MM
LC DCP/ DCP.
• SEGMENTAL FRACTURE ARE PLATED WITH 2
OVERLAPPING DCP ON IPSILATERAL SURFAFCE OF
ULNA.
• CULIBALY et.al. RECOMMENDED SURGERY IF 50%
DISPLACEMENT AND ANGULATION MORE THAN 8
DEGREE.

85. OPEN FRACTURES OF RADIUS AND ULNA
• PRINCIPLES OF MANAGEMANT:
1. WOUND CULTURE SHOULD BE TAKEN FOLLOWED
BY PROPHYLACTIC ANTIBIOTIC.
2.EXTENSIVE DEBRIDEMENT
3.ORIF OR EXTERNAL FIXATION?
4.IF POSSIBLE ,SOFT TISSUE INJURY SHOULD BE
RECONSTRUCTED WITHIN 72 HOURS.

86. • IF COMPARTMENT HAS BEEN DIAGNOSED OR IF
OPERATIVE WOUND CANNOT BE CLOSED WITH OUT
TENSION PORTION OF WOUND PROXIMALLY AND
DISTALLY ARE CLOSED.
• REMANING WOUND IS LEFT OPEN AND COVERED
WITH ANTIBIOTIC IMPREGNATED GAUGE.
• WOUND IS CLOSED SECONDARILY WITH SPLIT
THICKNESS GRAFTS 3 TO 5 DAYS AFTER PRIMARY
SURGERY.

87. MODULAR EXTERNAL FIXATOR

88. FRAME CONSTRUCTION OF ULNA

90. FRAME CONSTRUCTION OF RADIUS

92. EARLY COMPLICATIONS
1. NERVE PALSY: POSTERIOR INTEROSSEOUS
NERVE
SUPERFICIAL RADIAL NERVE
DORSAL BRANCH OF ULNAR
NERVE
2.COMPARTMENT SYNDROME:
MORE COMMON AFTER HIGH ENERGIES INJURIES
IMMEDIATE DECOMPRESSION OF THE TWO
ANTERIOR COMPARTMENT AND ONE POSTERIOR
FASCIAL COMPARTMENT.

93. LATE COMPLICATIONS
1.COMPLEX REGIONAL PAIN SYNDROME:
• MORE COMMON AFTER FOREARM AND WRIST
FRACTURES.
• APPROPRIATE ANALGESIA REGIMEN AND EARLY
MOVEMENT IS THE TREATMENT OF CHOICE
2. RADIOULNAR SYNOSTOSIS: CROSS UNION
UNCOMMON BUT TROUBLESOME
INCIDENCE 2-6%

94. LATE COMPLICATIONS
• POSSIBLE RISK FACTORS OF SYNOSTOSIS ARE:
• FRACTURE OF RADIUS ULNA AT SAME LEVEL.
• INJURY TO INTEROSSEOUS MEMBERANE.
• DELAYED FIXATION
• COMBINED SINGLE APPROACH FOR FIXATION
• POSTOPERATIVE CAST IMMOBILIZATION
• SEVRE SOFT TISSUE DAMAGE AND
MULTIFRAGMENTARY FRACTURE.

95. LATE COMPLICATIONS
• TREATMENT OF SYNOSTOSIS ARE:
• EXCISION FO HETEROTOPIC OSSIFICATION
,CONTRACTED SOFT TISSUE AND EARLY RANGE OF
MOTION.
• HETEROTOPIC OSSIFICATION SHOULD BE MATURE.
• NONUNION:

96. SUMMARY
• goal of treatment is:
1.COMPLETE OSSEOUS HEALING
2.RESTORATION OF STABLE FOREARM ROTATION
WITH FULL ELBOW AND WRIST RANGE OF MOTION.
3.FUNCTIONAL OUTCOME LARGELY DEPENDS ON
RECONSTRUCTION OF RADIAL BOW AND PERFECT
ANATOMICAL RESTORATION OF PRUJ AND DRUJ.

97. BIBLIOGRAPHY
• CAMPBELL’S OPERATIVE ORTHOPAEDICS 14TH
EDITION VOL 3
• AO PRINCIPLES OF FRACTURE MANAGEMENT 3RD
EDITION 2020(RADIUS ULNA SHAFT BY JOHN T
CAPO)
• ROCKWOOD AND GREEN’S FRACTURE IN ADULTS
8TH EDITION

98. •
• THANK YOU