Forearm Fractures in Emergency Medicine Clinical Presentation

  • Author: Toluwumi Jegede, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Mar 13, 2012
 

History

History is usually consistent with a direct blow to the forearm or a fall directly onto the forearm or outstretched hand. Understanding the mechanism of injury helps direct the physical examination to detect injuries.

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Physical

  • Patients usually have localized pain, tenderness, and swelling at the fracture site.
  • Fractures are classified as open or closed.
    • Consider any puncture or break in the skin over a fracture site evidence of an open fracture unless proven otherwise.
    • Infection is commonly seen with open fractures and warrants emergent orthopedic evaluation.
    • Incidence of open forearm fractures is second only to those of the tibia.
    • Open fracture classification system[6, 7]
      • Type I - Puncture wound less than 1 cm, minimal contamination
      • Type II - Laceration greater than 1 cm; moderate soft tissue damage; adequate bone coverage
      • Type IIIA - Extensive soft tissue damage, often high energy with massive contamination and adequate bone coverage
      • Type IIIB - Extensive soft tissue damage with bone exposure, flap coverage usually required
      • Subtype IIIC - Arterial injury requiring repair
    • The Gustilo classification system has significant interuser variability; the extent of the wound is often indeterminable until intraoperative exploration.
  • Perform a neurologic examination.
    • Evaluate sensory function by 2-point discrimination.
    • Assess motor function by having the patient make the following maneuvers: "OK" sign tests median nerve, extending the fingers or wrist against resistance tests radial nerve, and separating the fingers against resistance tests the ulnar nerve.
    • Tendons or muscle bellies entrapped in fracture fragments may account for unusual functional deficits.
  • Perform a vascular examination. Check capillary refill, radial pulse, and Allen test.
  • Examine the wrist and elbow for tenderness and range of motion.
    • Palpate the wrist to evaluate for ulnar styloid fracture, dorsal prominence of the ulna, or wrist pain with rotation.
    • Tenderness or prominence of the radial head may be the only physical finding in patients with reduced Monteggia lesion or radial head fracture.
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Causes

  • Sports, particularly in-line skating, skateboarding, scooter riding, mountain biking, and contact sports
  • Trauma, commonly from automobile collisions, blows with a blunt object, or child abuse
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Contributor Information and Disclosures
Author

Toluwumi Jegede, MD  Resident Physician, Department of Emergency Medicine, State University of New York Downstate Medical Center College of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Antonia Quinn, DO  Assistant Professor, Assistant Residency Director, Department of Emergency Medicine, State University of New York Downstate Medical Center/Kings County Hospital Center; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Antonia Quinn, DO is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francis Counselman, MD, FACEP  Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School

Francis Counselman, MD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Association of Academic Chairs of Emergency Medicine (AACEM), Norfolk Academy of Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Tom Scaletta, MD  Chair, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine

Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Enoch Huang, MD, Peter Grimes, MD, and Joneigh Slaughter Khaldun, MD, to the development and writing of this article.

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Fractures of the radius and ulna with dorsal angulation of distal fragments.
Torus fracture of the radius.
Torus fracture of the radius.
 
 
 
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