Diagnosis and treatment of bipolar fracture-dislocation of the forearm

Abstract

Objective To investigate diagnosis and surgical treatment of bipolar fracture-dislocation of the forearm. Methods A retrospective study was conducted of 16 patients with forearm bipolar fracture-dislocation who had been treated and completely followed up at Department of Orthopaedic Trauma, Beijing Jishuitan Hospital from March 2011 to September 2017. They were 14 males and 2 females, aged from 17 to 48 years (average, 35.8 years). Their injury involved 7 left and 9 right sides, and 10 dominant and 6 non-dominant sides as well. Their proximal injury was divergent elbow dislocation in 4 cases, convergent elbow dislocation in one case, Monteggia fracture-dislocation in 9 cases (2 ones of type I, 2 ones of type ⅡB, 4 ones of type ⅡC and one of type Ⅳ), and upper radioulnar dislocation in 2 cases. Their distal injury was distal radial fracture (intra-articular)+lower radioulnar dislocation in 7 cases, distal radioulnar fracture+lower radioulnar dislocation in 2 cases, Galeazzi fracture (1/3 distal humeral shaft) in 3 cases, and middle and upper middle radial fracture+lower radioulnar dislocation in 4 cases. Open reduction and internal fixation was performed for all the shaft fractures and most of the distal radial fractures. One distal radius fracture was treated with closed reduction and external fixation, one case with external fixation, one case with needle insertion and external fixation, 3 radial head fractures with internal fixation, 3 cases with radial head replacement, 2 cases untreated, 5 cases with open ligament repair because their primary closed reduction failed, and 2 cases with hinged external fixation of the elbow. Their functional exercise started according to judgment of joint stability after surgery. At the last follow-up, the overall function of the forearm was evaluated according to the Anderson＇s scoring. Results The 16 patients were followed up for an average of 26.0 months (from 6 to 60 months). All fractures healed at the internal fixation sites after operation with no abnormality affecting the function. No infection occurred. All the elbow joints and upper and lower radioulnar joints were stable. All the radial head replacements were in good position. The range of elbow flexion and extension averaged 123.2° (from 60° to 140°), the range of wrist flexion and extension 150.3° (from 120° to 160°), and the rotational mobility of the forearm 144.4° (from 70° to 170°). At the last follow-up, according to the Anderson's scores, 11 cases were rated as excellent, 3 cases as satisfactory, one case as unsatisfactory and one case as failure. Conclusions Most of the forearm bipolar fractures and dislocations are high-energy injury. The key to treatment is to achieve good reduction of distal and proximal dislocations and to start rehabilitative exercise as early as possible. Intraoperative fixation of fractures should be based on stable reduction of the dislocation. Fine reduction of bipolar dislocations and early rehabilitation can lead to good functional recovery. Key words: Forearm injuries; Dislocations; Fractures, bone; Diagnosis; High energy injury