Broken Forearm: Radius, Ulna, and Both Bone Fractures

Different Types of Forearm Fractures and Treatment Options

forearm fracture
A fracture of both bones of the forearm. DEPT. OF CLINICAL RADIOLOGY, SALISBURY DISTRICT HOSPITAL / Getty Images

A forearm fracture occurs when there is a fracture of one or both of the bones of the forearm. The two bones of the forearm are the radius and the ulna. Both bones are important for proper motion of the elbow and wrist joints, and both bones serve as important attachments to muscles of the upper extremity.

The most common types of fractures occur due to a fall onto the hand, or a direct blow to the forearm (commonly seen in altercations, sports injuries, and car accidents).

Symptoms of a forearm fracture include pain, swelling, and deformity of the forearm. Diagnosis of a forearm fracture can be made with a proper physical examination and x-ray studies.

Fractures of the forearm bones that occur around the elbow (radial head fractures and olecranon fractures) and those that occur around the wrist (wrist fractures), are considered elsewhere. Discussed here are radial shaft fractures, ulnar shaft fractures, and fractures of both forearm bones.

Radial Shaft Fractures

An isolated fracture of the radial shaft is an unusual injury. More commonly, fractures of the radial shaft are associated with injury to the ulna (see 'both bones forearm fracture' below) or injury to one of the joints around the wrist (Galeazzi fracture).

When an isolated radial shaft fracture occurs, it commonly requires surgery unless the fracture is non-displaced. If the fracture is out of position, then forearm rotation could be limited unless the fracture is realigned.

For this reason, most radial shaft fractures are treated with surgery to realign and hold the bones in proper position.

Ulnar Shaft Fractures

An isolated fracture to the ulna, often called a "nightstick" fracture, most often occurs during an altercation. When someone defending themselves raises their forearm in a protective posture, the ulna bone is exposed and can be damaged from a blunt traumatic exposure.

The name of the fracture is from people defending themselves from a policeman's nightstick sustaining ulnar fractures.

When the fracture is reasonably well aligned, an isolated ulna fracture is generally treated with immobilization in a cast. When the fracture is badly displaced, or the skin is broken causing an open fracture, a surgical treatment may be advised.

Both Bones Forearm Fracture

A both bones fracture is an injury that almost always requires surgery in an adult patient. Without surgery, the forearm is generally unstable and there is no ability to cast this type of fracture in a proper orientation.  In younger children, nonsurgical treatment can be considered, but even in adolescents surgery may need to be performed. 

Both bones forearm fractures are most commonly treated by placing a metal plate and screws on both the radius and ulna bones. These bones must each be approached through a separate incision, therefore you will have two incisions on your forearm. Some surgeons will use a rod within the bone to maintain the position of the bone, but this cannot be done in fractures where rotational stability is an issue. Therefore, most both bones forearm fractures are treated with a plate and screws.

Complications of Forearm Fractures

The most common complications of these fractures include:

  • Decreased Motion: Limited motion is common after the treatment of forearm fractures. Motion can be limited in the elbow and wrist joints, but is most commonly noticed as a limitation of forearm rotation (i.e. opening a jar or turning a door handle).
  • Non-Healing Fracture: The bones of the forearm can have inadequate healing leading to persistent pain. This is especially true with forearm fractures where bone is lost because of the type of fracture (i.e. many small pieces) or open fractures. Repeat surgery for bone grafting may be necessary in these cases.
  • Infection: Infection can occur after any surgical procedure. When an infection occurs after fixation of a forearm fracture, the metal plate and screws may require removal in order to cure the infection.
  • Painful Hardware: The metal implants used during surgery may be felt under the skin, and they may be painful. If they do cause discomfort they can be removed, usually at least a year after surgery.

Sources:

Pace JL "Pediatric and Adolescent Forearm Fractures: Current Controversies and Treatment Recommendations" J Am Acad Orthop Surg. 2016 Nov;24(11):780-788.

Schulte LM, Meals CG, Neviaser RJ "Management of adult diaphyseal both-bone forearm fractures" J Am Acad Orthop Surg. 2014 Jul;22(7):437-46.

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