Radius and ulnar shaft fracture!

Radius and ulnar shaft fracture!

Ouch, radius and ulnar shaft fracture, aka broken forearm!

This young patient got injured after his back foot slipped and he landed on his arm.

The injury may be sustained from a direct blow or an indirect injury involving a bending or rotational force placed on the forearm.

The patient with a midshaft forearm fracture typically complains of pain, and possibly deformity, at the site immediately following trauma. The mechanism involves either low energy (eg, ground-level fall, especially in older adults) or relatively high energy (eg, motor vehicle accident, or collision during a sporting event).

Physical examination begins with visual inspection, which may reveal swelling and an obvious deformity, suggesting a displaced fracture, or a wound overlying the fracture site (ie, open fracture) requiring immediate surgical evaluation.

Range of motion may be limited due to pain, and testing should be performed gently, judiciously, and only if there are no obvious signs of displaced fracture or dislocation.

In cases of suspected midshaft forearm fracture, anteroposterior and lateral radiographs showing the entire length of the radius and ulna are usually diagnostic.

Due to significant displacement, the initial treatment is closed reduction that is attempted when fracture angulation exceeds 10 degrees or displacement exceeds 50%.

Reduction involves placing the patient's affected arm in finger traps while the brachium is secured with a strap or weights. This setup allows for ready manipulation of the forearm and rapid splinting once reduction is achieved.

After satisfactory alignment is achieved, the fractured arm is placed in a long-arm posterior splint with the elbow at 90 degrees and the wrist in neutral (ie, without supination or pronation) and slight extension for 7 to 10 days.

After the period of immobilization, the cast or splint is removed, and the patient is placed in a functional forearm brace for four to six more weeks. The functional brace, which is generally custom-made to fit the patient, allows full flexion and extension at the elbow and wrist and full pronation and supination of the forearm.