Forearm Fractures in Emergency Medicine Treatment & Management

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

Prehospital Care

Stabilize the arm to prevent or limit neurovascular injury from sharp bone fragments.

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Emergency Department Care

  • Immobilize the forearm and upper arm and provide effective analgesia unless the patient has other injuries with the potential for hemodynamic or respiratory instability.
  • Identify other injuries. Because forearm fractures require considerable force, perform a complete physical examination to exclude other injuries.
  • Assess the injured forearm.
    • Perform a careful examination of the upper extremity to identify neurovascular deficits, tense muscle compartments, and disruptions of the skin.
    • Obtain appropriate radiographs to define fracture(s) and evaluate for associated dislocation.
  • Treat injury expeditiously.
  • Provide adequate analgesia/anesthesia.
  • Perform emergent reduction, if necessary. The bone ends may shift, resulting in the loss of reduction. This may occur in the first 10-14 days, or it may occur 6-8 weeks later.
  • Immobilize injury.
  • Administer antibiotics and tetanus immunization, as indicated.
  • Immediate fracture reduction is indicated when any of the following exists:
    • Neurovascular compromise
    • Severe displacement
    • Tenting of the skin
  • ED anesthesia/analgesia options
    • Axillary block provides complete anesthesia and muscle relaxation but carries the risk of arterial or nerve injury.
    • Hematoma block provides anesthesia and muscle relaxation but carries the risk of osteomyelitis.
    • Intravenous regional anesthesia (Bier block) provides anesthesia and muscle relaxation but carries the risk of lidocaine toxicity.
    • Conscious sedation provides effective anesthesia, muscle relaxation, and amnesia. It carries the risk of respiratory depression and requires increased nursing time.
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Consultations

  • Consult an orthopedist for open fractures, operative fractures, or dislocations, and arrange close follow-up care.
  • Fracture reductions typically are deferred to an orthopedist unless evidence of neurovascular compromise is noted.
  • Insufficient evidence exists to support a specific management technique of isolated fractures of the ulna.
  • Some evidence indicates that distal radius fractures may have better outcomes with external fixation or pinning than with conservative, nonsurgical management.
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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.

References

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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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