Executive Editor: Chris Colton

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

Forearm shaft Wedge fracture of one bone with a simple or wedge fracture of the other

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Glossary

General considerations

Fractures of both bones may occur with a wedge fracture of one or both bones. They can occur in the proximal, middle, or distal third of the shaft. These fractures usually require surgical fixation in order to allow for functional aftertreatment. Surgical fixation is usually achieved by plating. Other techniques, such as intramedullary nailing of one bone, or external fixation as a temporary measure, may be an option 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
May be an option in compromised patients Some specialized surgical experience Basic equipment only

Minimally displaced fractures in compromised individuals 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 a 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