Forearm Fracture

Aka: Forearm Fracture, Midforearm Fracture, GRUM Mnemonic

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II. Definitions

  1. Forearm Fracture
    1. Mid-shaft Fracture of the radius and/or ulna

III. 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

IV. 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

V. Types: Proximal Forearm and Elbow

  1. Supracondylar Fracture of Humerus (most common in children)
  2. Radial Head Fracture (most common in adults)

VI. Signs

  1. Usually shortened and displaced

VII. 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)

VIII. Imaging

  1. Xray should show entire Forearm including wrist and elbow

IX. Indications: Referral

  1. Orthopedic referral is indicated in most cases

X. 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

XI. 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

XII. 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

XIII. References

  1. Bhandari (2004) J Orthop Trauma 18(7): 473-5 [PubMed]
  2. Black (2009) Am Fam Physician 80(10): 1096-102 [PubMed]

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Ontology: Fracture of forearm (C1305215)

Concepts Injury or Poisoning (T037)
ICD10 S52 , S52.9
SnomedCT 208292008, 213497006, 65966004
English Fract of forearm, unspecif, Fracture of forearm, part unspecified, Fracture of forearm, unspecified, [X]Fract of forearm, unspecif, [X]Fracture of forearm, unspecified, Unspecified fracture of forearm, forearm fractures of, Fracture;forearm, forearm fractures, forearm fracture, fracture of forearm, fracture forearm, [X]Fracture of forearm, unspecified (disorder), Fracture of forearm (diagnosis), fracture upper limb forearm, Forearm fracture, Fracture of forearm, Fracture of forearm (disorder), Fracture of forearm, NOS, Forearm Fracture, fractured forearm
Italian Frattura dell'avambraccio
Japanese 前腕骨折, ｾﾞﾝﾜﾝｺｯｾﾂ
German Fraktur des Unterarmes, Teil nicht naeher bezeichnet, Fraktur des Unterarmes, Fraktur des Unterarms
Czech Zlomenina předloktí
Korean 아래팔의 골절, 상세불명의 아래팔 부분의 골절
Hungarian Alkartörés
Spanish fractura del antebrazo, fractura del antebrazo (trastorno), [X]fractura del antebrazo, no especificada, [X]fractura del antebrazo, no especificada (trastorno), fractura de antebrazo (trastorno), fractura de antebrazo, Fractura de antebrazo
Dutch Fractuur van onderarm, deel niet gespecificeerd, onderarmbreuk, Fractuur van elleboog en onderarm
Portuguese Fractura do antebraço
French Fracture de l'avant bras
Derived from the NIH UMLS (Unified Medical Language System)

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