Middle-Third Forearm Fractures Workup

Updated: May 31, 2019
  • Author: David A Forsh, MD; Chief Editor: Harris Gellman, MD  more...
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Workup

Imaging Studies

Middle-third forearm fractures are routinely diagnosed with standard anteroposterior (AP) and lateral radiographs of the forearm. Radiographs must visualize the entirety of the forearm, including both the elbow and the wrist. (See the images below.) Dedicated radiographs of the elbow and wrist should also be performed to evaluate for associated injuries to these joints. This is particularly important for ruling out Galeazzi and Monteggia fracture-dislocations in the setting of isolated fractures of the radius or the ulna, respectively. In some instances, additional oblique views of the forearm may be helpful to better assess fracture pattern when there is overlap of the radius and ulna on the standard lateral view.

Anteroposterior radiograph of displaced midshaft b Anteroposterior radiograph of displaced midshaft both-bone forearm fracture in adolescent with transitional growth plate. This fracture should be treated as adult injury.
Anteroposterior radiograph of open middle-third fr Anteroposterior radiograph of open middle-third fracture of radius and ulna. Joints above and below fracture are visible.
Lateral radiograph of displaced midshaft both-bone 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.
Lateral radiograph of open middle-third fracture o Lateral radiograph of open middle-third fracture of radius and ulna. Note proximity of bones to soft tissue.
Middle-third forearm fracture. Middle-third forearm fracture.
Middle-third forearm fracture. Middle-third forearm fracture.

On radiographs, the position of the bicipital tuberosity on the proximal radius can help in assessing the degree of pronation or supination of the proximal fracture fragment.

Computed tomography (CT) and magnetic resonance imaging (MRI) are rarely required for the assessment of acute forearm fractures. Advanced imaging is reserved for instances of middle-third forearm fractures involving pathologic lesions or unusually long fractures that extend into the wrist or elbow joint. [32]