What is the forearm?
The forearm is the area of the arm between the wrist and the elbow and is composed of two bones, the radius and ulna. The radius and ulna form a ring-link structure that links the elbow to the wrist. Filling in the space between the radius and ulna is a soft-tissue structure called the interosseous membrane.
For the purpose of this section, we will only discuss shaft (i.e. middle portion) fractures of the radius and the ulna. Fractures of the portion of the radius bone near the wrist (i.e. the distal radius) and the elbow (i.e. radial head and olecranon) are covered in different sections on the website.
How do forearm fractures occur?
Most forearm fractures occur from a fall on an outstretched hand or direct trauma to the forearm (i.e. being struck with an object). Fractures can also occur as a result of a motor vehicle accident, or anything that precipitates a fall such as a sports injury.
Patients usually present with pain and swelling along the forearm. Some patients may have a visible deformity. It is also important to realize that many nerves and vessels travel through the forearm. Although rare, these structures can be injured following a fracture. It is therefore very important that you see a doctor IMMEDIATELY should you suspect a forearm fracture.
Something called compartment syndrome can also develop. Although rare, a forearm fracture can lead to significant swelling and increased pressure within the forearm compartments containing muscles, blood vessels, and nerves. This pressure becomes so high that it can compress the nerves and blood vessels, leading to VERY SEVERE pain that is worsened with finger movement. The forearm compartment usually becomes very rigid and hard as well. Compartment syndrome is considered a SURGICAL EMERGENCY. It is therefore extremely important that you seek medical attention IMMEDIATELY if you experience any of the symptoms of compartment syndrome.
X-rays are normally first ordered to further evaluate the fracture pattern. A CT may be ordered if more detail involving the fracture is needed.
Treatment of forearm fractures depends on the age of the patient, location of the fracture, displacement of the fracture, whether or not both the radius and ulna are involved, and if there is any dislocation of the joints at either end of the radius and ulna.
Most nondisplaced forearm shaft fractures (i.e. fractures where the bones have not shifted) can be treated nonoperatively with a long-arm cast that goes above the elbow. Children, unlike adults, have an increased ability to remodel (realign) fractures without surgery and can therefore withstand slightly more displacement than adults. In children, if a manipulation of the bone is necessary, this is usually performed in the operating room so as to provide the least traumatic experience for the child with the use of some sedation/anesthesia.
In general, surgery is normally indicated for any displaced forearm fractures. Even some nondisplaced fractures in adults such as fractures that also result in dislocation of the joints at either end of the radius and ulna, will typically require surgery. Surgery may also be indicated for various other fracture patterns and locations. The type of surgery performed depends on the age of the patient, fracture pattern, and fracture location. Surgeries to relocate and stabilize the fracture can range from pins placed through the skin into the bone, plate and screws, or a metal nail placed into the center of the bone.
Dr. Steven Lee is the Chief of Hand and Upper Extremity at Lenox Hill Hospital, and as such is frequently referred many of the most challenging and complex cases related to forearm trauma.
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Patients are usually placed into an above the elbow splint following surgery and then transitioned into an above the elbow cast one week after surgery. Patients usually remain in this cast for up to 5 weeks. Physical therapy usually begins 6 weeks after surgery. If stable fixation can be achieved with surgery, the rehab protocol may be advanced from what is stated above. Any pins, if placed, are removed prior to starting physical therapy. Patients will normally perform 6-12 weeks of physical therapy and can expect to return to normal activity/sports 3-4 months after surgery.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.