Forearm fractures by Dr Bipul Borthakur

1. FOREARM FRACTURE
DR. BIPUL BORTHAKUR
Professor, Dept. of Orthopaedics, SMCH

2. INTRODUCTION
 Anatomy:

3.  Radius is slightly curved and ulna is relatively
straight. This has to be maintained post reduction.
 Forearm comprises of three joints:
 Proximal radio-ulnar joint
 Distal radio-ulnar joint
 Interosseous membrane

4.  Interosseous membrane
 It divides the forearm into anterior and posterior
compartment.
 It helps in shifting of load from the distal radius to
proximal ulna.

5. FRACTURE BOTH BONE
 MECHANISM OF INJURY
 High energy trauma like road traffic accident.
 Direct trauma – while protecting one’s head
 Gunshot wounds
 Falls from height or during athletics

6. FRACTURE BOTH BONE
 CLINICAL FEATURES:
 Pain
 Swelling
 External deformity
 Tenderness
 Abnormal mobility
 Decreased ROM
 Bony crepitus

7. FRACTURE BOTH BONE
 INVESTIGATIONS:
 Plain radiograph of forearm with
elbow and wrist joint –
anteroposterior and lateral view
 Location and pattern of fracture
 Look for subluxation or dislocation of
radio-ulnar joints

8. MANAGEMENT
 Clinically look for:
 Swelling, external injury, deformity, crepitus, abnormal
mobility, restriction of movement.
 any distal neurovascular deficit.
 radial and ulnar pulse; radial, median and ulnar nerves.
 Look for signs of compartment syndrome.
 Stabilization of the fractured forearm with splint/
slab is necessary.

9. FRACTURE BOTH BONE
 TREATMENT:
 Non-operative
 Closed reduction and well molded long arm cast or splint can be
applied for undisplaced or minimally displaced fractures, especially in
children less than 10 years.
 Position of forearm rotation of immobilization
 Proximal 1/3rd – Supination
 Middle 1/3rd – Neutral
 Distal 1/3rd - Pronation

10. FRACTURE BOTH BONE
 TREATMENT:
 Operative – Indications
 Unstable or unacceptable reduction
 Open fracture
 Floating elbow
 Re-fracture with displacement
 Segmental and comminuted fracture
 Age – older than 10 years (adolescents)

11.  The patient is put on slab application until swelling
subsides.
 Once the swelling is subsided operative
management can be done
 Plate fixation
 Titanium elastic nailing
 External fixation

12. FRACTURE BOTH BONE
 OPERATIVE:
 Closed or open reduction with
flexible nails like TENS for fractures
in adolescents.

13.  OPERATIVE:
 Plate fixation – compression plating or
bridge plating in adults.

14.  OPERATIVE:
 External fixation can be done
in open fractures.

15. FRACTURE BOTH BONE
 COMPLICATIONS:
 Early
 Neurovascular injury
 Compartment syndrome
 Late:
 Non-union or malunion
 Infection
 Volkmann’s ischemic contracture
 Post-traumatic radio-ulnar synostosis