Content

Aims
Indications
Contraindications
Techniques
Principles
Approaches
Position
Incision
Procedure
Postop/Rehab
Complications / Dangers

ORIF Fracture Radius & Ulna Shafts

Aims

Stable anatomic reduction & internal fixation allowing early mobilisation

Indications

Any fracture of radius and/or ulna shaft in an adult & especially if displaced (due to multiple muscle attachments with angulation & rotational forces which can lead to malunion & non-union)

Contraindications

? Highly contaminated open fracture requiring washout before formal fixation
Relatively contraindicated in children in that not usually required

Techniques

Compression plate & screws
IM nailing (not discussed below as not usual technique)

Principles

Careful stripping of periosteum (just enough to allow application of plate)
Accurate reduction including reduction & lagging of comminuted fragments
Expose both fractures & temporarily fix before applying plates
Definitively fix most stable & least comminuted fracture first
Centre plates over fracture with at least 4 or preferably 6 cortices each side of fracture ensuring plates are well contoured to bone
Autogenous bone graft for comminuted fractures (>1/3 circumference) though avoid IO membrane to prevent synostosis
Secure fixation that allows early postoperative mobilisation without a cast
Removal of plates only if symptomatic & not before 2 years due to high refracture rates

Approaches

Radius

Volar Henry approach (especially distal third fractures)
Dorsal Thompson approach (especially proximal third fractures)

Ulna: Posterior approach to subcutaneous border

Position

Supine with arm on hand table & torniquet applied

Incision

Depends on approach

Procedure

Via appropriate approach expose fracture & carefully strip periosteum from bone ends
Remove haematoma from fracture ends with curette
Accurately reduce fracture by matching fracture interdigitations
Choose & contour a plate to the bone (using templates)
Apply plate & hold with plate reduction forceps
Insert 1^st screw closest to fracture in neutral position
Insert 2^nd screw closest to fracture on other side in compression position
Insert remaining screws in neutral position
Close subcutaneous fat & skin only

Postop / Rehab

If patient cooperative & good fixation then bandage or backslab only for approximately 1/52 until comfortable & then mobilise entire arm as tolerated
If patient or fixation dodgy then may require full cast
No heavy lifting or strenuous activity until fracture(s) healed

Complications / Dangers

Neurovascular injury (depending on approach – see below)
Malunion/Nonunion
Infection
Loss of position requiring further fixation