The diagnosis and treatment in patients with a bipolar fracture-dislocation of the forearm: a retrospective study

Abstract

Backgrounds: This study aims to investigate the treatment and clinical effect of bipolar fracture-dislocation of the forearm.

Methods: From March 2011 to September 2021, patients with bipolar fracture-dislocation of the forearm admitted to XXX and XXX Hospital were retrospectively analyzed. The timing of rehabilitation depended on the joint stability after the operation. The forearm function was evaluated according to the Anderson forearm function score.

Results: A total of 40 patients who underwent surgical treatment were screened, but only 24 received a minimum of 6 months of follow-ups and were included in the study. Nineteen males and five females were enrolled in the study, with an age range of 18-65 years and an average of 40.4 years. With an average follow-up of 23.6 months (7-62 months), no case was related to functional malformations and infections. The average range of motion of flexion and extension at the elbow was 125.9° (98°-138°), the average range of motion of flexion and extension at the wrist was 144.2° (120°-156°), and the average range of motion of rotation at the forearm was 139.6° (88°-170°). The Anderson's forearm function score of the last follow-up presented: excellent in 16 cases, satisfactory in 6 cases, dissatisfactory in 1 and failure in 1.

Conclusions: Bipolar fracture-dislocation of the forearm always represents high-energy injuries, of which the treatment principle includes complete reduction in distal and proximal dislocations and rehabilitation training as early as possible. Intraoperative fracture fixation follows after a stable reduction in the dislocation.

Keywords: Diagnosis; Elbow dislocations; Forearm injuries; Fractures; High-energy injury.

Fig. 1

a–b: Preoperative radiographs show a classic Monteggia and Galeazzi fracture, also named “floating radius.” c–d This patient received an ORIF and plaster fixation with the forearm

Fig. 2

a–c: A 42-year-old right-hand dominant male case showed a Bado II C Monteggia fracture and distal radius fracture with dislocation of the distal radioulnar joint. d–f: The patient was treated with K wires and an external fixator, ORIF of the ulnar shaft and a repair of the lateral ligament of the elbow was also applied. Worth mentioning was that the external fixator was removed at 6 weeks postoperatively

Fig. 3

a–d: A 25-year-old male sustaining a radius shaft fracture combined divergent elbow dislocation and distal radioulnar joint dislocation. e–f: During operation, elbow dislocation was reduced by traction. Internal fixation of the radius shaft was performed using locking plates and reattached with an endobutton plate of the distal radioulnar joint. g–j: At the 7-month follow-up, the patient received an examination of the range of motion and an excellent clinical outcome compared with the opposite side

Fig.4

a–f: A 35-year-old female, whose preoperative radiographs demonstrated a distal radius and radius head fracture, fell from a two-story height. Furthermore, posterior dislocation of the proximal ulna with displaced radius head fracture was diagnosed as a sign of convergent elbow dislocation. g–j: With the failure of initial closed reduction under general anesthesia for elbow dislocation, open reduction was attempted to unlock the stuck radius head. ORIF of distal radius fracture followed after replacement of radius head and repair of lateral collateral ligament and joint capsule. k–p: At the latest follow-up after the injury, the patient had nearly full range of motion of her elbow and wrist