Signs and Symptons
The fracture is evaluated by taking several x-rays of the forearm that include the elbow joint and wrist joint. Special imaging studies such as a CAT Scan or MRI Scan are usually unnecessary. Your provider will also want to make sure that there has been no damage to the nerves and blood vessels and that there is no evidence of a compartment syndrome beginning. This can usually be accomplished with a careful physical examination.
Nearly all forearm fractures require surgery. If the fracture is an open fracture (also called a “compound” fracture) there is a surgery that will be necessary immediately to reduce the risk of infection. An open fracture occurs when there is a laceration through the skin at the fracture site. This can be caused by either the ends of the fracture tearing out through the skin or an external object puncturing the skin from the outside. If there is evidence that a compartment syndrome is beginning, surgery will be immediately necessary to relieve the pressure in the muscle compartments affected; the fracture will be fixed during the procedure as well.
If the fracture is not “open” and there is no concern for a compartment syndrome, you may be placed in a bulky, long arm splint to stabilize the arm until surgery can be scheduled. In some cases, surgery may not be necessary. If the fracture involves only the ulna and the fracture fragments have not displaced or angulated (meaning that they remain aligned with the two ends of the fractured bone together), your surgeon may recommend treating the fracture with a cast or fracture brace instead of surgery.
Most forearm fractures require Open Reduction and Internal Fixation (ORIF) using a metal plate and screws. This type of treatment allows the fracture to be fixed anatomically, meaning that the bones can be restored to their normal position and held there with the plate and screws until healing occurs. It is important that the radius and ulna be restored as close as possible to normal to ensure that the radius can rotate around the ulna. This means that both the angle and the rotation of the two fracture fragments needs to be restored to normal in addition to making sure that the two ends of the bone are back together. In most cases this is best achieved with ORIF using a plate and screws.
The intramedullary rod is not commonly used to treat forearm fractures, but in some special circumstances it can be used to reduce the need for making incisions in the forearm. The intramedullary rod is a metal rod that is placed inside the hollow shaft of a tubular bone such as the radius or ulna. The metal rod can be inserted into the bone through a small incision at either the wrist or elbow. The intramedullary rod is inserted with the aid of a special X-ray machine called a fluoroscope. The fluoroscope allows the surgeon to see an X-ray image of the bones on a television monitor and guide the placement of the intramedullary rod by viewing this image.
External fixation is not commonly used for forearm fractures. This type of treatment may be necessary for open fractures when the risk of infection is high or there has been loss of bone leaving a gap; for example, when the fracture is due to a gunshot. The external fixation device allows the surgeon to place metal pins through the skin and into the bone fragments away from the fracture site. These metal pins are then connected to a metal frame outside the skin. Thus, the fracture is stabilized, but there are no foreign materials (such as metal plates) in the fracture site to harbor the infectious bacteria. The fracture is less likely to develop osteomyelitis, an infection of the bone.
The fracture fragments may fail to heal; this is referred to as a nonunion. The fracture fragments may also heal in an unacceptable alignment; this is called malunion. Both of these complications may result in pain, loss of strength and a decreased range of motion of the shoulder. A second operation may be needed to treat the complication.