forearm

AKA

Diaphyseal Aclasis / Multiple Osteochondromas

Definition

Heritable skeletal dysplasia

Epidemiology

AD with variable penetrance (96%)

Malignant Transformation

Incidence of malignant transformation much higher 

- 10% overall

- 1 % / year

Chondrosarcoma (CS) > Osteosarcoma (OS)

1.  Antebrachial Compartment Syndrome

Aetiology

Supracondylar fracture of humerus

Both bone forearm fractures

Examination

Anatomy

Radial bow radius

- important for rotation

Interosseous membrane

- Z pattern

- proximal radius to distal ulna

Mechanism

Direct blow

- ulna / night stick

Ossification

Primary

- 8 / 52 gestation radius & ulna

Secondary

- distal radius age 1

- distal ulna age 5

Non Operative Management

Unacceptable Position

< 10:  > 15^o malalignment

> 10:  > 10^o malalignment

Postreduction Positionin / Rule of Thirds 

Definition

Circulation of tissues within a closed osteofascial space are compromised by increased pressure within that space

Most common 

- anterior leg compartment

- flexor compartment forearm

- deep posterior leg compartment

Aetiology

Prerequisite is volume restricting envelope 

- fascia & skin

- POP

- dressings

1.  Increased contents

Bleeding / edema 

- fracture

General Principles

All possible length should be preserved consistent with clinical judgement

- function of amputated stumps decrease progressively with each higher level of amputation 

- prosthetic rejection by patient increases with the more proximal amputations

- most ADL'S can be performed adequately with one limb, so don't use prosthesis

- all nerves are drawn distally into wound & sectioned so they retract well proximally to bone level of amputation