Ipsilateral fracture of distal and proximal ends of the radius: Does this injury pattern deserve special attention?

Ipsilateral proximal and distal radial fractures represent an injury spectrum following trauma due to axial loading of forearm. This spectrum may vary from a minimal (undisplaced fractures at either ends) to a severe insult (associated proximal and distal ulnar fracture, comminution, displaced fragments and probable interosseous membrane damage). Series of five cases on ipsilateral proximal and distal radial fractures and their results. Two of these cases occurred in paediatric age group. Both these injuries commonly result from a fall on outstretched hand. In older age group, especially osteoporotic elderly women, the fracture pattern can be a result of low energy trauma with minimal displacement of fractures. In younger age group, the injury complex mainly results from high-energy trauma with comminution, instability and significant soft tissue damage. The proximal fractures might be a part of a more severe elbow dislocation which may not be obvious at the time trauma radiographs are taken. The main sequellae in the series were related to involvement of radial head. In the paediatric group, the fracture pattern was complicated by avascular necrosis of radial epiphysis and premature physeal fusion. Ipsilateral proximal and distal radial fracture is an uncommon injury pattern. The series illustrates a number of problems associated with this combination. Firstly, one should be aware of this rare injury pattern and there should be greater emphasis on clinical examination of elbow in cases of wrist injuries and vice versa. Once diagnosed, one faces the dilemma of appropriate management in these cases. The appropriate management will depend on the injury characteristics including the age of the patient and the fracture pattern. One should try to preserve the radial head to prevent a possible proximal radial migration especially in younger patients. In children, these injuries are extremely prone to complications and forewarning the parents of a possible poor result while treating these injuries is important. [ABSTRACT FROM AUTHOR]