Forearm Fractures in Emergency Medicine Clinical Presentation

Updated: May 09, 2016
  • Author: Toluwumi Jegede, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Presentation

History

History is usually consistent with a direct blow to the forearm or a fall directly onto the forearm or outstretched hand. Understanding the mechanism of injury helps direct the physical examination to detect injuries.

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Physical

 

Patients usually have localized pain, tenderness, and swelling at the fracture site. Fractures are classified as open or closed. Consider any puncture or break in the skin over a fracture site evidence of an open fracture unless proven otherwise. Infection is commonly seen with open fractures and warrants emergent orthopedic evaluation. Incidence of open forearm fractures is second only to those of the tibia.

Open fracture classification system [7, 8]  is as follows:

  • Type I - Puncture wound less than 1 cm, minimal contamination
  • Type II - Laceration greater than 1 cm; moderate soft tissue damage; adequate bone coverage
  • Type IIIA - Extensive soft tissue damage, often high energy with massive contamination and adequate bone coverage
  • Type IIIB - Extensive soft tissue damage with bone exposure, flap coverage usually required
  • Subtype IIIC - Arterial injury requiring repair

The Gustilo classification system has significant interuser variability; the extent of the wound is often indeterminable until intraoperative exploration.

Perform a neurologic examination. Evaluate sensory function by 2-point discrimination. Assess motor function by having the patient make the following maneuvers: "OK" sign tests median nerve, extending the fingers or wrist against resistance tests radial nerve, and separating the fingers against resistance tests the ulnar nerve.

Tendons or muscle bellies entrapped in fracture fragments may account for unusual functional deficits.

Perform a vascular examination. Check capillary refill, radial pulse, and Allen test.

Examine the wrist and elbow for tenderness and range of motion. Palpate the wrist to evaluate for ulnar styloid fracture, dorsal prominence of the ulna, or wrist pain with rotation.Tenderness or prominence of the radial head may be the only physical finding in patients with reduced Monteggia lesion or radial head fracture.

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Causes

Sports, particularly in-line skating, skateboarding, scooter riding, mountain biking, and contact sports

Trauma, commonly from automobile collisions, blows with a blunt object, or child abuse

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