Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents following high-energy trauma to the forearm. Reports severe pain, localized swelling, and deformity of the proximal forearm. Neurovascular status is intact, though patient notes paresthesia in the distribution of the posterior interosseous nerve (PIN). Mechanism of injury consistent with a fall on an outstretched hand (FOOSH) with forced pronation.
Clinical Examination Findings
Physical examination reveals obvious deformity of the proximal ulna with palpable tenderness. Radial head prominence noted anteriorly/laterally, suggesting dislocation. Range of motion at the elbow is severely restricted and painful. Distal neurovascular exam: Radial and ulnar pulses 2+, capillary refill <2 seconds. PIN function assessment: Check for weakness in thumb extension and finger MCP joint extension.
Treatment Protocol
Emergent orthopedic consultation for closed reduction and casting, or open reduction internal fixation (ORIF) of the ulnar fracture and stabilization of the radial head. Maintain elbow in flexion to stabilize the radial head. Post-operative management includes neurovascular monitoring and serial radiographic assessment to ensure maintenance of reduction.