Executive Editor: Chris Colton

Authors: Dominik Heim, Shai Luria, Rami Mosheiff, Yoram Weil

Forearm shaft Simple fracture of the radius and the ulna

back to skeleton

Glossary

General considerations

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.

Nonoperative treatment
Indication summary Skill Equipment
Minimally displaced fractures Basic surgical experience, no specialized skills Basic equipment only

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.

External fixation
Indication summary Skill Equipment
A means of temporary fixation for severely open fractures Some specialized surgical experience Simple surgical and imaging resources

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
Indication summary Skill Equipment
Treatment of choice Some specialized surgical experience Simple surgical and imaging resources

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.

*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v2.0 2013-07-09