Rush Copley Family Medicine Residency, Aurora, IL, USA.
University of Virginia, Charlottesville, VA, USA.
Am Fam Physician. 2021 Mar 15;103(6):345-354.
Fractures of the radius and ulna are the most common fractures of the upper extremity, with distal fractures occurring more often than proximal fractures. A fall onto an outstretched hand is the most common mechanism of injury for fractures of the radius and ulna. Evaluation with radiography or ultrasonography usually can confirm the diagnosis. If initial imaging findings are negative and suspicion of fracture remains, splinting and repeat radiography in seven to 14 days should be performed. Incomplete compression fractures without cortical disruption, called buckle (torus) fractures, are common in children. Greenstick fractures, which have cortical disruption, are also common in children. Depending on the degree of angulation, buckle and greenstick fractures can be managed with immobilization. In adults, distal radius fractures are the most common forearm fractures and are typically caused by a fall onto an outstretched hand. A nondisplaced, or minimally displaced, distal radius fracture is initially treated with a sugar-tong splint, followed by a short-arm cast for a minimum of three weeks. It should be noted that these fractures may be complicated by a median nerve injury. Isolated midshaft ulna (nightstick) fractures are often caused by a direct blow to the forearm. These fractures are treated with immobilization or surgery, depending on the degree of displacement and angulation. Combined fractures involving both the ulna and radius generally require surgical correction. Radial head fractures may be difficult to visualize on initial imaging but should be suspected when there are limitations of elbow extension and supination following trauma. Treatment of radial head fractures depends on the specific characteristics of the fracture using the Mason classification.
桡骨和尺骨骨折是上肢最常见的骨折，其中远端骨折比近端骨折更为常见。摔倒时手掌撑地是导致桡骨和尺骨骨折最常见的损伤机制。通过 X 射线或超声检查通常可以确诊。如果初始影像学检查结果为阴性，但仍怀疑有骨折，应进行夹板固定，并在 7 至 14 天后再次进行 X 射线检查。无皮质中断的不完全压缩骨折，称为 buckle（环状）骨折，在儿童中很常见。有皮质中断的青枝骨折在儿童中也很常见。根据成角程度， buckle 和青枝骨折可通过固定来治疗。在成年人中，桡骨远端骨折是最常见的前臂骨折，通常由摔倒时手掌撑地引起。无移位或轻度移位的桡骨远端骨折最初采用糖钳夹板固定，然后用短臂石膏固定至少 3 周。需要注意的是，这些骨折可能会合并正中神经损伤。孤立的尺骨干（警棍）骨折通常由直接撞击前臂引起。这些骨折可通过固定或手术治疗，具体取决于移位和成角的程度。涉及尺骨和桡骨的复合骨折一般需要手术矫正。桡骨头骨折在初始影像学检查中可能难以发现，但在创伤后出现肘伸直和旋后受限时应怀疑有该骨折。桡骨头骨折的治疗取决于使用 Mason 分类的骨折具体特征。
