Forearm Fracture

1. See Also
   1. Distal Radius Fracture
   2. Galeazzi Fracture
   3. Monteggia's Fracture
   4. Colles Fracture
   5. Smith's Fracture
   6. Supracondylar Fracture of Humerus
   7. Radial Head Fracture
2. Definitions
   1. Forearm Fracture
      1. Mid-shaft Fracture of the radius and/or ulna
3. Types: Distal Forearm and Wrist
   1. Colles Fracture
      1. Distal Radius Fracture (often with ulnar styloid Fracture)
      2. "Dinner fork" deformity (distal fragment angulated dorsally)
   2. Smith's Fracture
      1. Distal Radius Fracture with displacement towards volar aspect
      2. Opposite of Colles Fracture
4. Types: Shaft
   1. Mnemonic: GRUM (from distal radius to proximal ulna)
      1. GR: Galeazzi - Radius Fracture
         1. Displacing the distal radius and injuring the Ulnar Nerve
      2. UM: Ulna - Monteggia Fracture
         1. Displacing the proximal radius and injuring the Radial Nerve (Wrist Drop)
   2. Galeazzi Fracture
      1. Fracture of the distal shaft of radius
      2. Dislocation of Distal radio-ulnar joint (ulna will appear medially displaced at the wrist)
         1. Risk of Ulnar Nerve injury
   3. Monteggia Fracture
      1. Proximal ulna Fracture of shaft (typically displaced)
      2. Proximal Radial Head Dislocation
         1. Risk of Radial Nerve injury
5. Types: Proximal Forearm and Elbow
   1. Supracondylar Fracture of Humerus (most common in children)
   2. Radial Head Fracture (most common in adults)
6. Signs
   1. Usually shortened and displaced
7. 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)
8. Imaging
   1. Xray should show entire Forearm including wrist and elbow
9. Indications: Referral
   1. Orthopedic referral is indicated in most cases
10. 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
11. 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
12. 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
13. References
    1. Bhandari (2004) J Orthop Trauma 18(7): 473-5 [PubMed]
    2. Black (2009) Am Fam Physician 80(10): 1096-102 [PubMed]