Executive Editor: Chris Colton

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

Forearm shaft

back to skeleton

Glossary

Basic treatment techniques

Oblique ulnar fracture: lag screw and plate fixation
Oblique radial fracture: lag screw and plate fixation
Transverse ulnar fracture: lag screw and plate fixation
Transverse radial fracture: lag screw and plate fixation
Ulnar wedge fracture: compression plating (and lag screw)
Radial wedge fracture: compression plating (and lag screw)
Segmental ulnar fracture: compression plating
Segmental radial fracture: compression plating
Comminuted ulnar fracture: bridge plating
Comminuted radial fracture: bridge plating
DRUJ stabilization (Galeazzi fracture-dislocation)
Radial head stabilization (Monteggia fracture-dislocation)
Basic technique: Modular external fixation

Surgical procedures sorted by fracture type

Use this menu to jump directly into a specific classification (optional):
A1.1 A1.2 A1.3 A2.1 A2.2 A2.3 A3 B1.1/2 B1.3 B2.1/2 B2.3 B3 C1 C2 C3.1 C3.2 C3.3
A1.1

Simple fracture of the ulna, radius intact, oblique

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Minimally displaced fractures Basic surgical experience, no specialized skills Basic equipment only
External fixation A means of temporary fixation for severely open fractures Some specialized surgical experience Simple surgical and imaging resources
Lag screw and plate fixation Treatment of choice Some specialized surgical experience Simple surgical and imaging resources
A1.2

Simple fracture of the ulna, radius intact, transverse

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Minimally displaced fractures Basic surgical experience, no specialized skills Basic equipment only
External fixation A means of temporary fixation for severely open fractures Some specialized surgical experience Simple surgical and imaging resources
Compression plating Treatment of choice Some specialized surgical experience Simple surgical and imaging resources
A1.3

Simple fracture of the ulna, radius intact, with dislocation of radial head (Monteggia)

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Surgical treatment not possible Basic surgical experience, no specialized skills Basic equipment only
External fixation A means of temporary fixation for severely open fractures Some specialized surgical experience Simple surgical and imaging resources
Plating with our without lag screw Treatment of choice Some specialized surgical experience Simple surgical and imaging resources
A2.1

Simple fracture of the radius, ulna intact, oblique

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Minimally displaced fractures Basic surgical experience, no specialized skills Basic equipment only
External fixation A means of temporary fixation for severely open fractures Some specialized surgical experience Simple surgical and imaging resources
Lag screw and plate fixation Treatment of choice Some specialized surgical experience Simple surgical and imaging resources
A2.2

Simple fracture of the radius, ulna intact, transverse

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Minimally displaced fractures Basic surgical experience, no specialized skills Basic equipment only
External fixation A means of temporary fixation for severely open fractures Some specialized surgical experience Simple surgical and imaging resources
Minimally invasive compression plating Transverse distal third radial shaft fractures Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Compression plating Treatment of choice Some specialized surgical experience Simple surgical and imaging resources
A2.3

Simple fracture of the radius, ulna intact, with dislocation distal radioulnar joint (Galeazzi)

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Surgical treatment not possible Basic surgical experience, no specialized skills Basic equipment only
External fixation A means of temporary fixation for severely open fractures Some specialized surgical experience Simple surgical and imaging resources
Plating with or without lag screw Treatment of choice Highly experienced and skilled surgeon Simple surgical and imaging resources
A3

Simple fracture of both bones

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Minimally displaced fractures Basic surgical experience, no specialized skills Basic equipment only
External fixation A means of temporary fixation for severely open fractures Some specialized surgical experience Simple surgical and imaging resources
Compression plating with or without lag screw Treatment of choice Some specialized surgical experience Simple surgical and imaging resources
B1.1/2

Wedge fracture of the ulna, radius intact

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Minimally displaced fractures Basic surgical experience, no specialized skills Basic equipment only
External fixation A means of temporary fixation for severely open fractures Some specialized surgical experience Simple surgical and imaging resources
Compression plating with or without lag screw Treatment of choice Some specialized surgical experience Simple surgical and imaging resources
B1.3

Wedge fracture of the ulna, radius intact, with dislocation of radial head (Monteggia)

Please select a treatment option:
Treatment Indication summary Skill Equipment
External fixation A means of temporary fixation for severely open fractures Some specialized surgical experience Simple surgical and imaging resources
Compression plating with or without lag screw Treatment of choice Highly experienced and skilled surgeon Simple surgical and imaging resources
B2.1/2

Wedge fracture of the radius, ulna intact

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Minimally displaced fractures Basic surgical experience, no specialized skills Basic equipment only
External fixation A means of temporary fixation for severely open fractures Some specialized surgical experience Simple surgical and imaging resources
Compression plating with or without lag screw Treatment of choice Some specialized surgical experience Simple surgical and imaging resources
B2.3

Wedge fracture of the radius, ulna intact, with dislocation of the distal radioulnar joint (Galeazzi)

Please select a treatment option:
Treatment Indication summary Skill Equipment
External fixation A means of temporary fixation for severely open fractures Some specialized surgical experience Simple surgical and imaging resources
Compression plating Treatment of choice Highly experienced and skilled surgeon Simple surgical and imaging resources
B3

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

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment May be an option in compromised patients Some specialized surgical experience Basic equipment only
External fixation A means of temporary fixation for severely open fractures Some specialized surgical experience Simple surgical and imaging resources
Compression plating Treatment of choice Some specialized surgical experience Simple surgical and imaging resources
C1

Complex fracture of the ulna, simple fracture of the radius

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Severely injured polytrauma patients; patients who are medically unfit for surgery Basic surgical experience, no specialized skills Basic equipment only
External fixation A means of temporary fixation for severely open fractures Some specialized surgical experience Simple surgical and imaging resources
Plating of one (C1.1) or both (C1.2/.3) bones Treatment of choice Highly experienced and skilled surgeon Simple surgical and imaging resources
Nailing (C1.3) Treatment option in the presence of severe soft-tissue injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
C2

Complex fracture of the radius, simple fracture of the ulna

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Severely injured polytrauma patients Some specialized surgical experience Basic equipment only
External fixation A means of temporary fixation for severely open fractures Some specialized surgical experience Simple surgical and imaging resources
Plating of one (C2.1) or both (C2.2/.3) bones Treatment of choice Some specialized surgical experience Simple surgical and imaging resources
Nailing (C2.3) Treatment option in the presence of severe soft-tissue injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
C3.1

Complex fracture of both bones, bifocal

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Severely injured polytrauma patients Basic surgical experience, no specialized skills Basic equipment only
External fixation A means of temporary fixation for severely open fractures Some specialized surgical experience Simple surgical and imaging resources
Compression plating Treatment of choice Highly experienced and skilled surgeon Simple surgical and imaging resources
C3.2

Complex fracture of both bones, Bifocal of one bone, irregular of the other

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Severely injured polytrauma patients Basic surgical experience, no specialized skills Basic equipment only
External fixation A means of temporary fixation for severely open fractures Some specialized surgical experience Simple surgical and imaging resources
Nailing Irregular fractures with severe soft-tissue injury (see discussion) Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Plating Treatment of choice Highly experienced and skilled surgeon Simple surgical and imaging resources
C3.3

Complex fracture of both bones, irregular

Please select a treatment option:
Treatment Indication summary Skill Equipment
Nonoperative treatment Severely injured polytrauma patients Basic surgical experience, no specialized skills Basic equipment only
External fixation A means of temporary fixation for severely open fractures Some specialized surgical experience Simple surgical and imaging resources
Nailing Treatment option in the presence of severe soft-tissue injury Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Bridge plating Treatment of choice in the absence of severe soft-tissue injury Highly experienced and skilled surgeon Simple surgical and imaging resources

Special considerations

Principles underlying forearm shaft fracture treatment
Principles of management of open fractures
Complications
Infection
Compartment syndrome
*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