Simple fractures of both bones can occur in the proximal, middle, or distal third of the shaft.
These unstable fractures usually require surgical fixation, in order to allow for functional aftertreatment. Surgical fixation usually involves plating. Other techniques, such as intramedullary nailing of one bone, or external fixation, as temporary stabilization, may be used in fractures with compromised soft tissues. Discussion of nailing in adult forearm shaft fractures is confined to multifragmentary fractures of both bones in adult AO Surgery Reference.
Minimally displaced fractures in adults may be treated nonoperatively; however, this is difficult and requires diligent follow up. For these reasons, whenever possible, these fractures are usually treated operatively.
|Minimally displaced fractures|
Minimally displaced fractures may be treated nonoperatively with a long-arm cast, possibly followed by bracing, including the proximal and distal joints. Frequent radiological monitoring of the fractures is advised to check for secondary displacement.
|A means of temporary fixation for severely open fractures|
External fixation can be indicated in severely open fractures as means of temporary fixation (with a view to later conversion to internal fixation).
|ORIF - Compression Plating|
|Treatment of choice|
The treatment of choice for displaced forearm shaft fractures is ORIF with absolute stability. This is achieved using a compression plate with or without lag screw.
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|