Forearm Fractures Clinical Presentation

Updated: Oct 30, 2015
  • Author: Gopikrishna Kakarala, MBBS, MS, MRCSEd; Chief Editor: Harris Gellman, MD  more...
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Presentation

History

Nondisplaced diaphyseal fractures of the shafts of both bones of the forearm are rare, and the deformity is often obvious, with the patient supporting the deformed and injured limb with the other hand. The symptoms include pain, deformity, and loss of function of the forearm. In these cases, excessive manipulation of the arm should be avoided to prevent further damage to the soft tissues.

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Physical Examination

Clinical examination should include a careful neurologic evaluation of the motor and sensory functions of the radial, median, and ulnar nerves. Check the vascular status and amount of swelling in the forearm. A tense compartment with neurologic signs or stretch pain should arouse the suspicion of compartment syndrome (see the first image below), and compartment pressures should be measured and monitored. This may be of significance in polytrauma patients or in comatose or obtunded patients. A low threshold should be maintained when deciding whether a fasciotomy is needed in patients with impending compartment syndrome.

Closed fracture of the forearm in the middle-third Closed fracture of the forearm in the middle-third area is complicated by compartment syndrome, with early blisters and a tense compartment.

Open fractures, especially those resulting from gunshot wounds, frequently have associated nerve and major blood vessel involvement. This involvement must be carefully evaluated. Urgent treatment is required for open fractures. A sterile dressing should be placed over the wound, and formal debridement should be reserved for the operating room.

The presence of ipsilateral fractures should be excluded, and a preliminary secondary survey should be performed to rule out other skeletal injuries.

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