Simple isolated fractures of the radius with a transverse or short oblique (< 30°) fracture line are typically treated by open compression plating and functional aftertreatment.
Intramedullary nailing of forearm fractures is currently limited to pediatric fractures and severe multifragmentary injuries of one or both forearm bones in the presence of devastating soft-tissue damage. Pediatric fractures are not included in this module of AO Surgery Reference. Discussion of nailing in adult forearm shaft fractures is confined to multifragmentary fractures of both bones in adult AO Surgery Reference.
|Minimally displaced fractures|
Minimally displaced fractures may be treated nonoperatively, usually with a long-arm cast, followed by a brace.
|A means of temporary fixation for severely open fractures|
External fixation can be indicated in severely open fractures as a means of temporary fixation (with a view to later conversion to internal fixation).
|MIO - Minimally invasive compression plating|
|Transverse distal third radial shaft fractures|
The minimally invasive ("limited open") technique is only applicable in the forearm for transverse distal third radial shaft fractures. This technique requires considerable surgical experience. The fractures best suited for this technique are those with a dorsal displacement of the distal fragment in the lateral view, with only minimal displacement in the AP view.
Fractures especially suitable are at the level of the abductor pollicis longus muscle belly.
Oblique distal radial shaft fractures are not suitable because indirect anatomical reduction and interfragmentary compression are difficult to achieve with this technique.
The advantage of the minimally invasive technique is the preservation of a skin bridge in the region of the abductor pollicis longus muscle.
|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.
|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|