Radius fractures can be divided into those that are proximal and those that are distal to the junction of the middle and distal thirds of the bone. Excluding radial head fractures, isolated fractures of the proximal two-thirds of the radius are not common because it is relatively well protected from direct blows by the ulna and also by the surrounding musculature of the forearm. Undisplaced fractures are rare; these are treated with cast immobilization. Fractures of the proximal two-thirds of the radius are often displaced by both the force of the injury and the action of the supinators and pronators on the radius. They require internal fixation with plating and screws to maintain the reduction and to prevent rotational deformity.
Fractures of the distal third of the radial shaft are produced by falls on the outstretched hand in forced pronation or by a direct blow. Much like the Monteggia fracture-dislocation, the distal radial shaft fracture is often associated with a distal radioulnar joint dislocation, hence the name reverse Monteggia fracture or, more commonly, Galeazzi fracture. There are localized tenderness and swelling over the distal radius and wrist. The radius fracture is usually short oblique or transverse with dorsal lateral angulation. The distal radioulnar joint injury can be subtle. Radiographs may show only a slightly increased distal radioulnar joint space on the anteroposterior view. On the lateral view, the ulna is displaced dorsally. This injury is treated by open reduction and internal fixation of the radius fracture with compression plating and screws. The distal radioulnar joint reduction is held with immobilization of the forearm in supination or with K-wire fixation for 6 weeks.
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