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Forearm Fracture
Aka: Forearm Fracture, Midforearm Fracture, GRUM Mnemonic
- See Also
- Distal Radius Fracture
- Galeazzi Fracture
- Monteggia's Fracture
- Colles Fracture
- Smith's Fracture
- Supracondylar Fracture of Humerus
- Radial Head Fracture
- Definitions
- Forearm Fracture
- Mid-shaft Fracture of the radius and/or ulna
- Types: Distal Forearm and Wrist
- Colles Fracture
- Distal Radius Fracture (often with ulnar styloid Fracture)
- "Dinner fork" deformity (distal fragment angulated dorsally)
- Smith's Fracture
- Distal Radius Fracture with displacement towards volar aspect
- Opposite of Colles Fracture
- Types: Shaft
- Mnemonic: GRUM (from distal radius to proximal ulna)
- GR: Galeazzi - Radius Fracture
- Displacing the distal radius and injuring the Ulnar Nerve
- UM: Ulna - Monteggia Fracture
- Displacing the proximal radius and injuring the Radial Nerve (Wrist Drop)
- Galeazzi Fracture
- Fracture of the distal shaft of radius
- Dislocation of Distal radio-ulnar joint (ulna will appear medially displaced at the wrist)
- Risk of Ulnar Nerve injury
- Monteggia Fracture
- Proximal ulna Fracture of shaft (typically displaced)
- Proximal Radial Head Dislocation
- Risk of Radial Nerve injury
- Types: Proximal Forearm and Elbow
- Supracondylar Fracture of Humerus (most common in children)
- Radial Head Fracture (most common in adults)
- Signs
- Usually shortened and displaced
- Complications
- High rate of non-union in adults
- Risk of unstable Fractures even when initially non-displaced and despite external immobilization
- Radial Head Dislocation in proximal ulnar Fracture (Monteggia Fracture)
- Imaging
- Xray should show entire Forearm including wrist and elbow
- Indications: Referral
- Orthopedic referral is indicated in most cases
- Management: Adults
- Displaced Forearm Fractures
- May attempt closed reduction
- Open reduction and Internal Fixation (ORIF)
- Usually indicated
- Length of immobilization is shorter
- Non-displaced Forearm Fractures
- Long Arm Cast with elbow at 90 degrees for 8-12 weeks
- Management: Children
- Surgical intervention rarely needed
- Reduction Technique
- Light Anesthesia
- Angulated Fractures
- Traction and Counter traction
- Greenstick Fractures
- Often require breakage of opposite cortex
- Prevents re-angulation in cast
- Displaced Fractures
- Traction and Counter traction
- Slight bayonet apposition is acceptable
- Alignment must be satisfactory
- Immobilization in Long Arm Cast for 7-8 weeks
- Elbow flexed to 90
- Mold Forearm to avoid interosseus encroachment
- Management: Follow-up
- Examine at weekly intervals for 3 weeks
- Inspect for re-angulation
- Angulation under 2 weeks
- Correct angulation manually
- Angulation over 2 weeks
- Angulation may be permanent
- References
- Bhandari (2004) J Orthop Trauma 18(7): 473-5 [PubMed]
- Black (2009) Am Fam Physician 80(10): 1096-102 [PubMed]