Forearm Fractures in Emergency Medicine Follow-up

  • Author: Toluwumi Jegede, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Mar 31, 2009
 

Further Inpatient Care

  • Admit the patient with a forearm fracture whenever the following conditions are present:
    • Open fracture
    • Presence of or potential for neurovascular compromise
    • Fracture requiring ORIF and orthopedist plans to operate expeditiously
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Further Outpatient Care

  • Most cases can be treated safely by splinting and referral to an orthopedist who will then schedule surgical repair (if necessary).
  • Elevate the injured extremity and limit physical activities to prevent further injury.
  • Provide instructional material on cast/splint care and symptoms requiring a return to the ED.
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Inpatient & Outpatient Medications

  • Prescribe oral analgesics (eg, NSAIDs, acetaminophen with codeine/hydrocodone).
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Transfer

  • Transfer to a facility with a higher level of care when no orthopedist is available and admission or urgent surgery is necessary.
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Deterrence/Prevention

  • Recommend wearing wrist guards while in-line skating, roller skating, or skateboarding.
  • Prevent osteoporosis in postmenopausal women.
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Complications

  • Direct neurovascular injury
  • Physeal arrest if fracture involves the growth plate
  • Radioulnar synostosis after delayed treatment
  • Compartment syndrome - Associated with closed shaft fractures of the radius or ulna and with tight casts. It is less common in upper extremities than in lower extremities.
  • Loss of supination-pronation after a forearm fracture
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Prognosis

  • Prognosis for recovery of forearm fractures (ie, good bony union, maintenance of function) is related to severity and type of fracture and is optimized by treating fractures early and appropriately.
  • Morbidity is related to missed or delayed diagnosis of an open fracture or dislocation associated with fracture.
  • Improvements in internal and external fixation materials and techniques have allowed more aggressive treatment of forearm fractures, with fewer complications and improved recovery of function.
  • Midshaft fractures tend to have worse outcomes than fractures in the distal or proximal third of the forearm.
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Patient Education

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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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