M.E.Müller: Atlas: Fracture 22-A3

Radius/Ulna, Diaphysis,
simple fracture,
both bones 0,54% of the total
4,19% of the radius/ulna
17,20% of the segment

34 fractures
11,6% group
64%M, 36%F

175 fractures
59,5% group
66%M, 34%F

85 fractures
28,9% group
60%M, 40%F

Radius, proximal section Radius, middle section Radius, distal section

These are simple fractures of both bones of the forearm, located at the proximal third, the middle third or the distal third of the diaphysis. Ref. Manual of Internal Fixation:
232 - 251. 466 - 475.
Surgeon. RO, RO, RO.

The coexistence of the fractures of both bones constitute an added instability factor for each one of them. The principles of surgical indication and technique that will be discussed for the A1 and A2 groups also apply to the A3 group, for which the requirement of anatomic reduction is even more strict.

Generally, the ulna should be reduced first because it is easier to reduce and to stabilize, either provisionally or definitively, and also because it will reconstitute the lenght of the forearm making the reduction of the radius easier. Once the radius is internally fixed, the stability of the ulna must then be checked because, conceptually, both internal fixations constitute one single treatment of one functional unit, therefore being interdependent. A precarious internal fixation of one of the bones will put

the other at risk of failure, even when the other internal fixation is perfect.

In the A3.1 case, a straight plate has been used in the ulna, perfectly adapted to its flat surface, combined with a one-third tubular plate in the radius that adapts better to its cylindrical shape. The A3.2 case shows the interfragmentary compression performed to the oblique fracture of the radius with a lag screw independent of the plate. In the A3.3 case the ulna is subcutaneous and a one-third tubular plate was used because of its better coverage by thin soft tissues. If the distal fragment is short, a “hook” plate can be made in order to obtain additional stability. The oblique fracture of the radius was stabilized with a lag screw and a protection (neutralization) plate.

preoperative + 4 months

preoperative + 4 months

preoperative postoperative + 1 year + 1 year




						Radius/Ulna, Diaphysis, simple fracture, both bones	0,54% of the total 4,19% of the radius/ulna 17,20% of the segment






These are simple fractures of both bones of the forearm, located at the proximal third, the middle third or the distal third of the diaphysis.		Ref. Manual of Internal Fixation: 232 - 251. 466 - 475. Surgeon. RO, RO, RO.

The coexistence of the fractures of both bones constitute an added instability factor for each one of them. The principles of surgical indication and technique that will be discussed for the A1 and A2 groups also apply to the A3 group, for which the requirement of anatomic reduction is even more strict. Generally, the ulna should be reduced first because it is easier to reduce and to stabilize, either provisionally or definitively, and also because it will reconstitute the lenght of the forearm making the reduction of the radius easier. Once the radius is internally fixed, the stability of the ulna must then be checked because, conceptually, both internal fixations constitute one single treatment of one functional unit, therefore being interdependent. A precarious internal fixation of one of the bones will put	the other at risk of failure, even when the other internal fixation is perfect. In the A3.1 case, a straight plate has been used in the ulna, perfectly adapted to its flat surface, combined with a one-third tubular plate in the radius that adapts better to its cylindrical shape. The A3.2 case shows the interfragmentary compression performed to the oblique fracture of the radius with a lag screw independent of the plate. In the A3.3 case the ulna is subcutaneous and a one-third tubular plate was used because of its better coverage by thin soft tissues. If the distal fragment is short, a “hook” plate can be made in order to obtain additional stability. The oblique fracture of the radius was stabilized with a lag screw and a protection (neutralization) plate.