eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Fracture, Forearm: Follow-up

Author: Joneigh Slaughter Khaldun, MD, Resident Physician, Department of Emergency Medicine, State University of New York Medical Center, Kings County Hospital
Coauthor(s): Robert J Gore, MD, Clinical Assistant Professor, Attending Physician, Assistant Residency Director, Department of Emergency Medicine, Kings County/State University of New York Downstate Hospital
Contributor Information and Disclosures

Updated: Mar 31, 2009

Follow-up

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

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.

Inpatient & Outpatient Medications

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

Transfer

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

Deterrence/Prevention

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

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

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.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to suspect DRUJ pathology in the face of isolated radial fracture (Galeazzi type)
  • Failure to suspect radial head dislocation in the face of isolated ulnar fracture (Monteggia type)
    • Radial head dislocations usually can be reduced or closed early in presentation, but delayed diagnosis commonly requires open reduction.
    • Lesions undiagnosed by the emergency physician are likely to be missed on outpatient follow-up visit.
    • Spontaneous reduction during splinting and loss of physical findings of pain at the radial head by the time of follow-up contribute to delayed or missed diagnosis
  • Failure to appreciate an open fracture (attributing wounds to a simple soft-tissue injury)
  • Failure to recognize neurovascular injury

Special Concerns

  • Suspect child abuse when the mechanism of injury is inconsistent with fracture type, especially in newborns and infants.
  • Realize that lesser amounts of mechanical force may result in fracture, especially in postmenopausal women.
 
Acknowledgments

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



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References
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Further Reading

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Keywords

forearm fracture, broken forearm, broken arm, arm fracture, limb fractures, limb fracture, fractured forearm, proximal forearm fractures, middle forearm fractures, forearm shaft fractures, distal shaft forearm fractures, osteoporosis

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Contributor Information and Disclosures

Author

Joneigh Slaughter Khaldun, MD, Resident Physician, Department of Emergency Medicine, State University of New York Medical Center, Kings County Hospital
Joneigh Slaughter Khaldun, MD is a member of the following medical societies: Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Robert J Gore, MD, Clinical Assistant Professor, Attending Physician, Assistant Residency Director, Department of Emergency Medicine, Kings County/State University of New York Downstate Hospital
Robert J Gore, MD is a member of the following medical societies: Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Francis Counselman, MD, Program Director, Chair, Professor, Department of Emergency Medicine, Eastern Virginia Medical School
Francis Counselman, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, Norfolk Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Tom Scaletta, MD, President, Emergency Excellence (EmEx) (www.emergencyexcellence.com); Assistant Professor of Emergency Medicine, Rush Medical College, Cook County Hospital; Chairperson, 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 and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

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, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
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

 
 
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