Middle-Third Forearm Fractures Clinical Presentation

Updated: Apr 17, 2023
  • Author: David A Forsh, MD; Chief Editor: Harris Gellman, MD  more...
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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).