Forearm Fracture

1. Definition
   1. Mid-shaft Fracture of the radius and/or ulna
2. Signs
   1. Usually shortened and displaced
3. Complications
   1. High rate of non-union in adults
   2. Risk of unstable Fractures even when initially non-displaced and despite external immobilization
   3. Radial Head Dislocation in proximal ulnar Fracture (Monteggia Fracture)
4. Imaging
   1. Xray should show entire Forearm including wrist and elbow
5. Indications: Referral
   1. Orthopedic referral is indicated in most cases
6. Management: Adults
   1. Displaced Forearm Fractures
      1. May attempt closed reduction
      2. Open reduction and Internal Fixation (ORIF)
         1. Usually indicated
         2. Length of immobilization is shorter
   2. Non-displaced Forearm Fractures
      1. Long Arm Cast with elbow at 90 degrees for 8-12 weeks
7. Management: Children
   1. Surgical intervention rarely needed
   2. Reduction Technique
      1. Light Anesthesia
      2. Angulated Fractures
         1. Traction and Counter traction
         2. Greenstick Fractures
            1. Often require breakage of opposite cortex
            2. Prevents re-angulation in cast
      3. Displaced Fractures
         1. Traction and Counter traction
         2. Slight bayonet apposition is acceptable
         3. Alignment must be satisfactory
   3. Immobilization in Long Arm Cast for 7-8 weeks
      1. Elbow flexed to 90
      2. Mold Forearm to avoid interosseus encroachment
8. Management: Follow-up
   1. Examine at weekly intervals for 3 weeks
   2. Inspect for re-angulation
      1. Angulation under 2 weeks
         1. Correct angulation manually
      2. Angulation over 2 weeks
         1. Angulation may be permanent
9. References
   1. Bhandari (2004) J Orthop Trauma 18(7): 473-5
   2. Black (2009) Am Fam Physician 80(10): 1096-102