What is a Forearm Fracture?
A forearm fracture is a break involving the bones of the forearm: the radius and the ulna. Either or both bones may sustain a fracture. The fracture may occur at any point along the length of the radius or ulna. They may occur where the radius joins the wrist, this type of forearm fracture is called a Colles Fracture. Radial head fractures occur at the union of the radius and the elbow. Proximal ulna fractures occur where the ulna joins the elbow.
Forearm fractures that occur in the shaft of the radius and ulna are the focus of this section. Forearm fractures occurring in adults and children have important differences. The bones of an adult are stronger and more mature than the bones of a child. In an adult the shaft of the bones of the forearm must sustain excessive force to break. Because of this, a forearm fracture in an adult will usually involve both the radius and the ulna, instead of just one bone. When only one bone is broken, it is usually a solitary ulna fracture in an adult who has raised the arm in defense from a direct blow. This is called a nightstick fracture.
The bones of growing children are more pliable than those of the adult. Pediatric forearm fractures are also more complicated due to the presence of growth plates in the bone. Growth plates are cartilaginous areas of bone where new bone cells are formed and hardened. They allow extension in the length of a bone as the child grows taller. Injury to the growth plate of a child’s bone can result in stunted growth or deformity. Growth plates also facilitate quicker repair of pediatric forearm fractures when compared to adult fractures.
The flexible bones of children lend themselves to unique types of fracture where the bones actually bend in response to force being applied to them. In a greenstick fracture, the bone bends on one side and a partial crack results on the opposite side. There is no displacement of the bone. A torus fracture occurs when the bone bends, causing a buckle in the outermost layers of the bone without causing an actual fracture line in the bone.
What Causes a Forearm Fracture?
Forearm fractures are caused by a fall on an outstretched hand or a direct blow to the forearm. In older persons, they may be complicated by osteoporosis. Rarely, they are due to pathologic changes in the bone such as a bone cyst or bone tumor.
What are the symptoms of a Forearm Fracture?
Pain is the most obvious symptom of a forearm fracture. Tenderness and swelling will be present over the location of the fracture. If an open fracture is present, there may be edges of bone sticking out through the skin.
How is a Forearm Fracture Diagnosed?
The history of the injury will suggest that a forearm fracture has occurred. The physical exam will check for injuries to the nerves and blood vessels. X rays are the gold standard for diagnosing forearm fractures and must include views not only of the forearm, but the wrist and elbow as well to exclude concomitant injuries. CT or MRI may be employed to assess vascular, neurological or soft tissue injury.
How is a Forearm Fracture Treated?
The method of treatment used for a forearm fracture depends on the age of the patient, the type of fracture sustained, and the degree of severity of the fracture.
In general, greenstick and torus fractures of the pediatric population can be managed by casting for 4-6 weeks. Even though a complete break has not occurred, these are areas of weakened bone. If the child were to fall on it again the bone may break all the way through.
If a child has a complete fracture, it may be reduced and splinted in the emergency department until the patient can be seen by an orthopedist to place a cast.
Adults who sustain a minimally displaced nightstick fracture of the ulna may undergo closed reduction in the emergency department with placement in a long arm splint while awaiting orthopedic follow up.
An open fracture where bones are sticking out of the skin will require emergent surgical repair.
Children rarely need surgery but it is indicated in those cases where the fracture remains unstable after closed reduction or if reduction cannot be performed.
Adults with moderate to severely displaced nightstick fractures will require open reduction and internal fixation.
Adults with a fracture of both the ulna and the radius are usually admitted for emergent surgery due to the highly traumatic nature of the injury and risk for compartment syndrome. In compartment syndrome swelling occurs in a fixed space, putting pressure on the nerves and blood vessels in such a way that normal circulation and sensation cannot occur. This can cause ischemic injury leading to tissue death, paralysis, and contractures.
Open reduction with internal fixation may be performed, but an external fixator may need to be used if many bone fragments are present.
How can Dr. Knight help you with forearm fractures?
Dr. Knight has years of experience in the treatment of catastrophic upper extremity injuries, particularly forearm fractures. Since this condition is painful, urgent treatment is necessary. Dr. Knight will expedite your treatment on the same day it is needed and provide at least temporary support of the fracture until definitive surgery can be performed. If surgery is needed, he will use the latest techniques and equipment to restore the forearm fractures to their original position.
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