Forearm fractures are a group of fractures that occur in the forearm following trauma. The radius and ulna are bound together at the proximal and distal radioulnar joints and act as a ring. Like elsewhere in the body, it is difficult to only fracture one bone if there is a bony ring. If the radius or ulna is fractured, it is likely there is another fracture or one of the radioulnar joints has been damaged.
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Epidemiology
Forearm fractures are seen in all age-groups although as with most simple trauma, there is a bimodal age and sex distribution with high-trauma injuries in the younger age-group and simple falls in the older age-group.
Clinical presentation
The majority of patients present with a history of trauma to the forearm and pain. They are reluctant to move their wrist or elbow and depending on the severity of the injury there may be a deformity.
An x-ray of the forearm will determine the type of injury that has occurred. In most cases, there will either be a paired radial and ulnar fracture or an isolated radial fracture and dislocation of the distal or proximal radioulnar joint.
Radiographic features
Forearm fractures are readily diagnosed on plain radiographs, and further imaging is rarely required.
Plain radiograph
AP and lateral X-rays of the forearm are performed.
A radial or ulnar fracture will be visible on at least one view. It is important to determine what type of fracture it is, e.g. transverse, oblique, comminuted.
If there is only one fracture, it is important to look for a second fracture, or see if there is damage to the proximal or distal radioulnar joint:
- Monteggia fracture-dislocation: ulna fracture and dislocation of the radial head at the elbow
- Galeazzi fracture-dislocation: radial fracture and dislocation of the distal ulna from the carpus
Treatment and prognosis
Treatment depends on the degree of displacement and/or comminution. These fractures are often accompanied by a significant amount of displacement and require reduction. If there is associated radial head or distal ulnar dislocation, manipulation with reduction of the fracture and dislocation is required.
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