Forearm fracture fixation
Forearm fracture is a complete or partial break in one or both of the two bones in the forearm. Forearm fractures occur most commonly in children and the elderly. The best treatment for forearm fracture depends on a number of factors, including age, past and present health, the severity of the fracture and history with one’s medications and other treatments.
A forearm fracture can cause significant pain and visible deformity. If you have been involved in some sort of trauma and believe your forearm may be injured, it is important to seek immediate medical attention. To diagnose your injury, your doctor will ask you questions about past medical history and the recent trauma (if any), as well as perform a physical exam. One of the following tests will be done to determine the extent of the injury:
- X-ray (radiograph) – This is the most common test performed to determine the extent of the injury. Electromagnetic radiation is sent through the arm to create an image of the bone structure. This will show which bones have been broken or displaced in the trauma, and if there are any pieces of bone that have come completely apart.
- Pulse test – In some cases, the blood flow may be restricted by the breakage, causing the hand to lose circulation. The doctor will test the wrist to find the pulse and determine if blood is still flowing to this part of the body.
In the majority of forearm fracture cases, surgery is required to ensure that both of the main bones (the radius and the ulna) return to normal function. However, most forearm fractures in children and adult forearm fractures involving only the ulna may be treated without surgery. These treatments include immobilizing the arm with a cast or splint. If necessary, the doctor will guide the bones to realignment prior to placing the forearm in a cast.
The purpose of most forearm fracture surgery is to hold both bones in place so that they return to normal function. Without anatomic alignment of the radius and ulna, forearm rotation will be severely limited. Most forearm fractures are treated in one of the following ways:
- Metal plate and screws – The most common surgical treatment uses metal plates and screws on both the ulna and radius to hold them in place as they heal. This helps to stabilize both bones so they can return to proper function. These plates and screws must be administered separately, usually requiring two incisions.
- Metal rod – In rare cases, a metal rod is placed through the center of the bone. This rod must be designed specifically for the forearm, otherwise the rod could limit the rotational abilities of the bone. For this reason, this procedure is not performed as often.
- External rotation – When there is significant damage to the skin and tissue surrounding the bone, making more incisions may cause further damage. In this case, external plates are screwed in to repair the bone without damage.
Much of the research surrounding forearm fractures has to do with children, as they are the ones who experience this type of fracture most often. One of the concerns is treating this oddly shaped bone as it continues to grow. Because surgery is needed in many cases to properly heal this bone, placing plates and screws on a growing body can lead to other issues.
Recently, a study was conducted by Dirk W. Summerfeldt, MD, in Hamburg, Germany. This study focused on the idea that in children, using an elastic intramedullary nail to repair the bone may allow the bone to remain stable, but also give it room to grow naturally. This technique was used only in distal fractures, or the fractures surrounding the lower part of the forearm. In the study, doctors calculated whether or not the elastic nails were a better fit for the child. They tested 122 children and in all but three cases had successful repair without complications. This number is higher than the success rate without complications using more traditional approaches for correcting distal fractures in children.
The forearm contains two bones, making repair more complex. As research on treatments continues to advance, children are expected to be able to regain their mobility faster and have fewer complications as a result of surgery.
As research on treatment methods is ongoing, it is a good idea for your conversation about it with your doctor to be ongoing as well.
The multidisciplinary team of trauma and fracture experts at Northwell Health Orthopaedic Institute performs forearm fracture surgery as well as a broad range of nonsurgical and surgical treatments for conditions that affect the bones.