5. Past & Personal history
•ปฏิเสธโรคประจาตัว
•ปฏิเสธประวัติอุบัติเหตุรุนแรงในอดีต
•ปฏิเสธประวัติผ่าตัด
•พัฒนาการสมวัย
•ไม่มียาที่ใช้เป็นประจา
6. Physical examination
• Primary survey : OK
• Vital signs : BP 109/69 mmHg, PR 87/min,Temp 36.6 C, RR
18/min
• HEENT : No wound or deformity. Not pale conjunctivae, anicteric
sclerae.
• Heart : Normal S1 S2, no murmur
• Lungs : Normal breath sound equal both lungs
• Abdomen : Soft, not tender
7. •Affected part : Rt.forearm
•Swelling with deformities, no visible wound
•Marked tender
•Limited ROM due to pain
•Intact sensation
•Capillary refill < 2 sec.
•Radial artery pulse 2+, equal to Lt.forearm
14. Introduction
• Fractures of the radial or ulnar shaft, or both, are relatively common and
account for 5% to 10% of children’s fractures.
• Fractures of the shaft of the radius and ulna may occur in the distal third,
middle third, or upper third; they are more common distally than proximally.
• Fractures of the forearm are more easily managed in children than in adults.
Closed treatment is usually successful, remodeling is significant, and
malunion is uncommon.
15. Mechanism of injury
• A fall on an outstretched hand is the most frequent mechanism of fracture
of the radial or ulnar shaft, or both.
• Both-bone forearm fractures may also be the result of direct trauma.
Frequently these are high-energy, open injuries with significant soft tissue
damage.
16. Diagnosis
• Fractures of the distal third, which are most common, are often
characterized by the classic dinner fork deformity of the forearm.
• Careful attention should be paid to the integrity of the skin
because forearm fractures are the most common open long-bone
fracture in children.
17. Radiographic findings
•It is important to obtain true AP and lateral views of the
forearm because oblique views may not reflect the
displacement accurately
19. Treatment
• Radial and ulnar shaft fractures can almost always be successfully treated by
closed reduction and cast immobilization.
• Reduction is usually performed in the emergency department under
conscious sedation. It is obtained by exaggerating the deformity, applying
traction, and reducing the fracture.Traction can be applied with the use of
finger traps, the aid of an assistant, or the surgeon’s lower extremity
21. • After reduction, a well-molded, sugar tong splint or cast is applied.
• After reduction and splinting or casting, the patient is discharged with
instructions to elevate the arm “with the fingers above the elbow and the
elbow above the heart.”
22. Operative treatment
• Indications
• Dysvascular extremities
• Compartment syndromes
• Irreducible fractures
• Entrapped tendons or nerves
• Open fractures
• Failure of closed reduction and casting
23. Options
• Open Reduction and Internal Fixation with compression plates and screws
• Flexible Intramedullary Fixation
• Single-Bone Fixation
• External Fixation
24. Complications
• Re-fracture
• Occurs in about 5% of patients
• More likely to occur after greenstick or open fractures
• Malunion
• Delayed union or non-union (rare)
• Synostosis (rare)
• Compartment syndrome
• Peripheral nerve injury
25. In this patient
•Set OR for ORIF with Plate & Screw (13/8/2016)
• Due to failed closed reduction
