eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Forearm Fractures: Workup

Author: Gopikrishna Kakarala, MBBS, MS (Ortho), MRCSEd, Fellow, Department of Orthopedics, New Cross Hospital, UK
Coauthor(s): Adrian W Simons, MBBS, FRCS(Orth), Consulting Staff, Department of Orthopedic Surgery - Hand Surgery, New Cross Hospital, UK
Contributor Information and Disclosures

Updated: Dec 19, 2008

Workup

Imaging Studies

  • The configuration of midshaft fractures of the radius and ulna varies depending on the mechanism of injury and the degree of violence involved. Low-energy fractures tend to be transverse or short oblique, whereas high-energy injuries are frequently extensively comminuted or segmented, often with extensive soft-tissue injuries.
  • At least 2 radiographic projections (ie, anteroposterior, lateral) of the forearm must be obtained. These show the fracture, the extent of displacement, and the extent of comminution. Attention should be directed toward finding any foreign bodies in open fractures and gunshot injuries.
  • Also imperative is to include the elbow and wrist joint in the radiographs of forearm fractures to ensure that radial head and distal radioulnar joint injuries are not missed. A line through the center of the radial shaft, neck, and head should pass through the center of the capitellum in any view of the elbow.
  • A tuberosity view may help ascertain the rotational displacement of the fracture. This would help in planning how much supination or pronation is needed to achieve accurate anatomic reduction. The ulna is laid flat on the cassette with its subcutaneous border in contact with the cassette; the x-ray tube is tilted toward the olecranon by 20°. This radiograph is then compared with a standard set of diagrams that show the prominence of the radial tuberosity in various degrees of pronation and supination in order to determine the scope of the rotational deformity.
  • CT scanning is useful in distal radius fractures and radioulnar joint pathologies.
  • MRI has limited utility in radioulnar injuries and is not indicated in uncomplicated forearm fractures.
  • Angiography or vascular Doppler ultrasonography is useful to determine the level of vascular injury in selected cases in which vascular injury is suspected.

More on Forearm Fractures

Overview: Forearm Fractures
Workup: Forearm Fractures
Treatment: Forearm Fractures
Follow-up: Forearm Fractures
Multimedia: Forearm Fractures
References
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References

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Further Reading

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Keywords

forearm fractures, distal-third forearm fractures,  middle third forearm fractures, forearm fracture in sports, fractures of the radius and ulna, ulna fracture, radius fracture, radial fracture, ulnar fracture, broken arm, broken ulna, broken radius, broken forearm, fracture of both bones of the forearm, compartment syndrome,

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Contributor Information and Disclosures

Author

Gopikrishna Kakarala, MBBS, MS (Ortho), MRCSEd, Fellow, Department of Orthopedics, New Cross Hospital, UK
Disclosure: Nothing to disclose.

Coauthor(s)

Adrian W Simons, MBBS, FRCS(Orth), Consulting Staff, Department of Orthopedic Surgery - Hand Surgery, New Cross Hospital, UK
Adrian W Simons, MBBS, FRCS(Orth) is a member of the following medical societies: British Orthopaedic Association
Disclosure: Nothing to disclose.

Medical Editor

Michael S Clarke, MD, Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine
Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Arthroscopy Association of North America, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, and Missouri State Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Thomas R Hunt III, MD, John D Sherrill Professor and Director of Orthopaedic Surgery, Surgeon in Chief of UAB Highlands Hospital, Director of Hand and Upper Extremity Fellowship, University of Alabama at Birmingham
Thomas R Hunt III, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, American Society for Surgery of the Hand, AO Foundation, Mid-America Orthopaedic Association, and Southern Orthopaedic Association
Disclosure: Tornier Consulting fee Review panel membership

CME Editor

Dinesh Patel, MD, FACS, Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital
Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Physicians of Indian Origin, American College of International Physicians, and American College of Surgeons
Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD, Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami School of Medicine
Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society
Disclosure: Nothing to disclose.

 
 
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