Simultaneous Fractures of Distal and Proximal Ends of Radius and Ulna: Four Fractures in One Forearm

Abstract

A few cases reported simultaneous ipsilateral distal and proximal forearm fractures. This case report highlights a rare mechanism of injury that occurred due to extended forearm undergoing forced hyper-supination without the presence of ligamentous injury and the use of flexible fixation. A 49-year-old male truck driver presented to the emergency department as a motor vehicle accident (MVA) patient. A radiographic examination revealed a right forearm fracture with proximal and distal bone fractures. The distal radius was stabilized with three Kirschner wires (K-wires), and the radial neck fracture was stabilized with a single intramedullary K-wire. The olecranon and distal ulna fractures were also fixed with two intramedullary wires. On the eighth week after surgery, all K-wires were removed, and the fiberglass splint was reapplied for another two weeks. After the cast was removed, physical rehabilitation began. During the fourth month, a follow-up radiograph revealed complete healing and full wrist range of motion (ROM) with good hand grip.

Keywords: distal; forearm; fractures; proximal; radius; ulna.

Figure 1. Fractures at the proximal level.

Anteroposterior (A) and lateral (B) radiography illustrating proximal ulna fracture with comminution and a radial neck fracture.

Figure 2. The fracture at the distal level.

Anteroposterior (A) and lateral (B) radiographs showing distal radius and ulna metaphyseal comminuted fracture with dorsal angulation and displacement.

Figure 3. Postoperative anteroposterior (A) and lateral (B) radiographs of the forearm showed a good reduction and restored alignment.

Three K-wires were used for the distal radius, and one intramedullary K-wire was used to fix the radial neck fracture. Two intramedullary wires were used to fix the olecranon and distal ulna fractures.

Figure 4. Anteroposterior (A) and lateral (B) wrist and distal forearm radiography done six weeks postoperatively.

Out of splint radiographs showing excellent healing with callus formation and alignment maintained (radial height, volar inclination).

Figure 5. Anteroposterior (A) and lateral (B) elbow and proximal forearm radiography done six weeks postoperatively.

Out of splint radiographs showing good healing process and alignment maintained.

Figure 6. Anteroposterior (A) and lateral (B) wrist and distal forearm radiography done 12 weeks postoperatively.

Radiographs showing good healing and alignment maintained (radial height, volar inclination).

Figure 7. Anteroposterior (A) and lateral (B) elbow and proximal forearm radiography done 12 weeks postoperatively.

Radiographs showing good healing and alignment maintained.