History
Middle-third forearm fractures may result from a lower-energy injury (eg, a ground-level fall or a fall onto an outstretched hand), from a direct blow, or from a higher-energy injury (eg, a fall from a height or a motor vehicle accident [MVA]). The mechanism of injury typically involves an axial load that is applied to the forearm through the hand. [3] The patient will complain of forearm pain and swelling, as well as visible deformity if there is displacement of the fracture. It is also important to assess for neurologic injury, as well as associated injuries in the ipsilateral extremity or elsewhere.
Physical Examination
On physical examination, the forearm will be swollen and may show gross deformity in cases where the fracture is displaced. There will be tenderness over the area of the fracture, and in cases without deformity, this should raise suspicion of a nondisplaced fracture. A careful inspection of the skin should be performed to rule out any open wounds. When open wounds are present, they most commonly occur on the ulnar side of the forearm.
In patients with middle-third forearm fractures, thorough neurologic and vascular examination of the ipsilateral extremity should be performed to evaluate for any peripheral nerve or vascular injuries, as well as associated injuries, particularly at the elbow and wrist. It is also important to evaluate for signs and symptoms of acute compartment syndrome in the forearm, especially after higher-energy injuries (though this can occur after lower-energy injuries as well).
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Anteroposterior radiograph of displaced midshaft both-bone forearm fracture in adolescent with transitional growth plate. This fracture should be treated as adult injury.
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Lateral radiograph of displaced midshaft both-bone forearm fracture in adolescent. Note that alignment in this view appears to be adequate; however, radius is short.
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Anteroposterior radiograph of completed open reduction and internal fixation (ORIF) of middle-third forearm fracture.
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Lateral radiograph of open middle-third fracture of radius and ulna. Note proximity of bones to soft tissue.
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Anteroposterior radiograph of open middle-third fracture of radius and ulna. Joints above and below fracture are visible.
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Anteroposterior radiograph of completed fixation of middle-third forearm fracture.
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Lateral radiograph of completed open reduction and internal fixation (ORIF) of middle-third forearm fracture.
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Middle-third forearm fracture.
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Middle-third forearm fracture.
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Middle-third forearm fracture.
