Management: Begin general management of forearm fractures.Injury from high-energy trauma: may show angulation > 10° and/or comminution.May show nondisplaced, displaced, or greenstick fractures of both shafts of the radius and ulna.Nerve injury is uncommon with closed fractures.Etiology: FOOSH injury (common in children), high-energy trauma (e.g., MVC).Epidemiology: more common in children.Definition: fracture of both the radial shaft and ulnar shaft.Refer to orthopedics within 7–10 days for surgical management.PLUS disruption of the i nterosseous membrane of the forearm.Displaced > 2mm: ORIF (e.g., with K-wire fixation)įractures with elbow and wrist involvement.Associated DRUJ instability: operative repair may be required.Nondisplaced fractures: Long-arm AP splint for 6 weeks.Often associated with distal radius fractures or other ulnar fractures.Avulsion or fracture of the ulnar styloid.Axial loading force applied against the distal radius.Intra-articular fracture of the lunate fossa of the distal radius.Avulsion and volar displacement of the radiocarpal segment.Radial avulsion and dorsal displacement of the radiocarpal segment of the radius.Flexion fracture: fall onto a palmar-flexed wrist.Radial and volar displacement of the distal fragment of the radius.Radial and dorsal displacement of the distal fragment of the radius.ORIF may be required (e.g., for displaced or unstable fractures).Immobilize with a posterior long-arm splint.Definitive management depends on the fracture location and degree of displacement.Initial immobilization with long-arm AP splint or sugar tong splint.Pediatrics: greenstick fractures common.( Combined radial and ulnar shaft fracture) Direct high-energy trauma to the forearm.Fall onto an outstretched and pronated forearm and extended wrist.Fracture of the proximal or middle ulna.For other bones that can be fractured in the elbow, see “ Distal humerus fractures.”.For other bones that can be fractured in the wrist, see “ Causes of wrist fractures.”.For further detail on distal radius fracture patterns, See “ Types of distal radius fractures.”.See “ Overview of radius and ulna fractures” for the various fracture patterns that can affect these bones.Although the term forearm fracture most often focuses on midshaft fractures of the radius and/or ulna, the proximal and distal portions of these bones which make up the wrist and elbow joints can also be involved. Arteries: the brachial artery and its branches, the radial artery and ulnar artery.Nerves: the radial nerve, ulnar nerve, and median nerve (including its branch anterior interosseous nerve).Joints: elbow joints (i.e., radiohumeral joint and humeroulnar joint), proximal radioulnar joint, wrist joints (i.e., radiocarpal joints), and distal radioulnar joint ( DRUJ).Connective tissue: interosseous membrane of the forearm, annular ligament of the radius.Ulna: composed of the olecranon process, coronoid process, ulnar shaft, and distal ulna (including ulnar styloid).Radius: composed of the radial head, radial shaft, and distal radius (including radial styloid).Relevant anatomy Important musculoskeletal structures Management varies depending on the age group and fracture characteristics, and includes a thorough neurovascular assessment, acute immobilization, pain management, and referral to orthopedics for definitive open reduction and internal fixation ( ORIF) or closed reduction and casting.įor more details on fractures involving the distal radius, see “ Distal radius fractures.” Overview Evaluation includes imaging of the forearm wrist and elbow imaging are added for moderate to severe injuries. Clinical presentation is typically characterized by pain near the fracture site, gross deformity, and swelling. The mechanism of injury can be low-energy, such as a fall on an outstretched hand ( FOOSH), or high-energy, such as a motor vehicle collision ( MVC). Fractures of the forearm bones at the elbow level include radial head fractures and olecranon fractures, while those at the wrist level include distal radius fractures. Important forearm fracture patterns include complete forearm fractures, Galeazzi fractures, and Monteggia fractures. Fractures of the radius and/or ulna occur frequently.
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