eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity

Forearm Fractures: Follow-up

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

Outcome and Prognosis

The prognosis for adults with fractures of the radius and ulna depends on many factors.19,20,21,22 However, the factors under the surgeon's control include choice of treatment method, timing of internal fixation in open fractures, soft-tissue handling, and restoration of osseous anatomy.

Anderson reported a union rate of 97.3% for fractures treated with open reduction and internal fixation using compression plates.13  Of these patients, 90% had satisfactory or excellent function, and only 10% had unsatisfactory or poor function. Sage reported a union rate of 93.8% for fractures treated with triangular nails.8

The important feature common to these studies, in which a union rate of more than 90% was reported, was the rigidity of the fixation. If intramedullary nails are used, they must control rotation of the fragments and be sturdy enough to resist angulatory forces. If plates and screws are used, they must be long enough and strong enough to resist loosening and breakage.

The prognosis is more guarded for open fractures of the shaft of the radius and ulna with major skin and soft-tissue loss. In these cases, several operative procedures may be necessary, including the initial debridement and stabilization, skin grafting, pedicle or free-flap applications,23 late reconstruction of the bones, and, frequently, tendon transfers.

 


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

  1. Singh S, Bhatia M, Housden P. Cast and padding indices used for clinical decision making in forearm fractures in children. Acta Orthop. Jun 2008;79(3):386-9. [Medline].

  2. Chung KC, Spilson SV. The frequency and epidemiology of hand and forearm fractures in the United States. J Hand Surg [Am]. Sep 2001;26(5):908-15. [Medline].

  3. Hotchkiss RN, An KN, Sowa DT, et al. An anatomic and mechanical study of the interosseous membrane of the forearm: pathomechanics of proximal migration of the radius. J Hand Surg [Am]. Mar 1989;14(2 Pt 1):256-61. [Medline].

  4. Schemitsch EH, Richards RR. The effect of malunion on functional outcome after plate fixation of fractures of both bones of the forearm in adults. J Bone Joint Surg Am. Aug 1992;74(7):1068-78. [Medline].

  5. Sarmiento A, Cooper JS, Sinclair WF. Forearm fractures. Early functional bracing - A preliminary report. J Bone Joint Surg Am. Apr 1975;57(3):297-304. [Medline].

  6. Droll KP, Perna P, Potter J, Harniman E, Schemitsch EH, McKee MD. Outcomes following plate fixation of fractures of both bones of the forearm in adults. J Bone Joint Surg Am. Dec 2007;89(12):2619-24. [Medline].

  7. Wright RR, Schmeling GJ, Schwab JP. The necessity of acute bone grafting in diaphyseal forearm fractures: a retrospective review. J Orthop Trauma. May 1997;11(4):288-94. [Medline].

  8. Sage FP. Medullary fixation of fractures of the forearm. A study of the medullary canal of the radius and a report of fifty fractures of the radius treated with a prebent triangular nail. J Bone Joint Surg Am. Dec 1959;41-A:1489-516. [Medline].

  9. Reinhardt KR, Feldman DS, Green DW, Sala DA, Widmann RF, Scher DM. Comparison of intramedullary nailing to plating for both-bone forearm fractures in older children. J Pediatr Orthop. Jun 2008;28(4):403-9. [Medline].

  10. Krzykawski R, Król R, Kaminski A. The results of locked intramedullary nailing for non-union of forearm bones. Ortop Traumatol Rehabil. Jan-Feb 2008;10(1):35-43. [Medline].

  11. Mseddi MB, Manicom O, Filippini P, Demoura A, Pidet O, Hernigou P. [Intramedullary pinning of diaphyseal fractures of both forearm bones in adults: 46 cases]. Rev Chir Orthop Reparatrice Appar Mot. Apr 2008;94(2):160-7. [Medline].

  12. Duncan R, Geissler W, Freeland AE, Savoie FH. Immediate internal fixation of open fractures of the diaphysis of the forearm. J Orthop Trauma. 1992;6(1):25-31. [Medline].

  13. Anderson LD. Fractures. In: Crenshaw AH, ed. Campbell's Operative Orthopaedics. 5th ed. Vol 1. St Louis, Mo: Mosby; 1971:477-691.

  14. McQueen MM, Wakefield A. Distal radial osteotomy for malunion using non-bridging external fixation: good results in 23 patients. Acta Orthop. Jun 2008;79(3):390-5. [Medline].

  15. Stern PJ, Drury WJ. Complications of plate fixation of forearm fractures. Clin Orthop Relat Res. May 1983;25-9. [Medline].

  16. Eaton RG, Green WT. Volkmann's ischemia. A volar compartment syndrome of the forearm. Clin Orthop Relat Res. Nov-Dec 1975;58-64. [Medline].

  17. Mih AD, Cooney WP, Idler RS, Lewallen DG. Long-term follow-up of forearm bone diaphyseal plating. Clin Orthop Relat Res. Feb 1994;256-8. [Medline].

  18. Bauer G, Arand M, Mutschler W. Post-traumatic radioulnar synostosis after forearm fracture osteosynthesis. Arch Orthop Trauma Surg. 1991;110(3):142-5. [Medline].

  19. Nagy L, Jankauskas L, Dumont CE. Correction of forearm malunion guided by the preoperative complaint. Clin Orthop Relat Res. Jun 2008;466(6):1419-28. [Medline].

  20. Souer JS, Lozano-Calderon SA, Ring D. Predictors of wrist function and health status after operative treatment of fractures of the distal radius. J Hand Surg [Am]. Feb 2008;33(2):157-163. [Medline].

  21. Osada D, Kamei S, Takai M, Tomizawa K, Tamai K. Malunited fractures of the distal radius treated with corrective osteotomy using volar locking plate and a corticocancellous bone graft following immediate mobilisation. Hand Surg. 2007;12(3):183-90. [Medline].

  22. Mackenney PJ, McQueen MM, Elton R. Prediction of instability in distal radial fractures. J Bone Joint Surg Am. Sep 2006;88(9):1944-51. [Medline].

  23. Mullett H, Hausman M, Zaidemberg C. Recalcitrant distal humeral and proximal forearm nonunion: salvage using an extended pedicled radial forearm osseous flap. J Trauma. Apr 2008;64(4):E60-4. [Medline].

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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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