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
Next

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.
Previous
Next

Inpatient & Outpatient Medications

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

Transfer

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

Deterrence/Prevention

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

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
Previous
Next

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.
Previous
Next

Patient Education

Previous
 
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.

References

  1. Simon RR, Sherman SC, Koenigsknecht SJ. Forearm. In: Emergency Orthopedics: The Extremities. 5th ed. McGraw-Hill; 2007:218-231.

  2. Benjamin H, Hang B. Common Acute Upper Extremity Injuries in Sports. Clin Ped Emerg Med. 8:15-30.

  3. Zalavras C, Nikolopoulou G, Essin D, et al. Pediatric fractures during skateboarding, roller skating, and scooter riding. Am J Sports Med. Apr 2005;33(4):568-73. [Medline].

  4. Gustilo RB, Mendoza RM, Williams DN. Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma. Aug 1984;24(8):742-6. [Medline].

  5. Zalavras CG, Patzakis MJ, Holtom PD, et al. Management of open fractures. Infect Dis Clin North Am. Dec 2005;19(4):915-29. [Medline].

  6. Gebuhr P, Holmich P, Orsnes T, et al. Isolated ulnar shaft fractures. Comparison of treatment by a functional brace and long-arm cast. J Bone Joint Surg Br. Sep 1992;74(5):757-9. [Medline].

  7. Anderson LD, Meyer FN, Lippincott JB. Fractures of the shafts of the radius and ulna. In: Rockwood and Green's Fractures in Adults. 3rd ed. Publishers: Lippincott-Raven; 1991:679-737.

  8. Carson S, Woolridge D, Colletti J, et al. Pediatric Upper Extremity Injuries. Ped Clin North Am. 2006;53:41-67.

  9. Cheng JC, Shen WY. Limb fracture pattern in different pediatric age groups: a study of 3,350 children. J Orthop Trauma. 1993;7(1):15-22. [Medline].

  10. Cramer KE, Glasson S, Mencio G, et al. Reduction of forearm fractures in children using axillary block anesthesia. J Orthop Trauma. 1995;9(5):407-10. [Medline].

  11. Eastell R. Forearm fracture. Bone. Mar 1996;18(3 Suppl):203S-207S. [Medline].

  12. Gleeson AP, Beattie TF. Monteggia fracture-dislocation in children. J Accid Emerg Med. Sep 1994;11(3):192-4. [Medline].

  13. Gregory PR, Sullivan JA. Nitrous oxide compared with intravenous regional anesthesia in pediatric forearm fracture manipulation. J Pediatr Orthop. Mar-Apr 1996;16(2):187-91. [Medline].

  14. Handoll HH, Madhok R. Closed reduction methods for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2003;4.

  15. Handoll HH, Madhok R. Surgical interventions for treating distal radial fractures in adults. Cochrane Database Syst Rev. 2003;4.

  16. Handoll HH, Pearce PK. Interventions for isolated diaphyseal fractures of the ulna in adults. Cochrane Database Syst Rev. 2004;CD000523. [Medline].

  17. Kay S, Smith C, Oppenheim WL. Both-bone midshaft forearm fractures in children. J Pediatr Orthop. May-Jun 1986;6(3):306-10. [Medline].

  18. Macule Beneyto F, Arandes Renu JM, Ferreres Claramunt A, et al. Treatment of Galeazzi fracture-dislocations. J Trauma. Mar 1994;36(3):352-5. [Medline].

  19. Metz VM, Gilula LA. Imaging techniques for distal radius fractures and related injuries. Orthop Clin North Am. Apr 1993;24(2):217-28. [Medline].

  20. Morgan WJ, Breen TF. Complex fractures of the forearm. Hand Clin. Aug 1994;10(3):375-90. [Medline].

  21. Newton EJ, Love J. Emergency department management of selected orthopedic injuries. Emerg Med Clin North Am. Aug 2007;25(3):763-93, ix-x. [Medline].

  22. Proust AF, Bredenkamp JH, Uehara DT. Injuries to the elbow and forearm. In: Tintinalli JE, ed. Emergency Medicine: A Comprehensive Study Guide. 6th ed. McGraw Hill Text: 2004:1690-1694.

  23. Singletary EM. Volar dislocation of the distal radioulnar joint. Ann Emerg Med. Apr 1994;23(4):881-3. [Medline].

  24. Younger AS, Tredwell SJ, Mackenzie WG, et al. Accurate prediction of outcome after pediatric forearm fracture. J Pediatr Orthop. Mar-Apr 1994;14(2):200-6. [Medline].

  25. Zautcke JL. Forearm Injuries. In: Hart RG, Rittenberry TJ, eds. Handbook of Orthopaedic Emergencies. Lippincott Williams & Wilkins Publishers: 1999:222-232.

 
Previous
Next
 
Fractures of the radius and ulna with dorsal angulation of distal fragments.
Torus fracture of the radius.
Torus fracture of the radius.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.