Forearm fracture

Forearm fractures have the second highest ratio of open to closed fractures among all fractures. They’re also common in children.

We distinguish simple forearm fractures from complex ones. Simple fractures are isolated fractures of the radius or ulna (sometimes called nightstick fracture). Complex fractures are fractures occurring with dislocations. The three most important complex fractures are:

Name	Fracture location	Dislocation location
Galeazzi	Distal radius	Radioulnar joint
Monteggia	Proximal ulna	Radial head
Essex-Lopresti	Radial head	Radioulnar joint (+ interosseus disruption)

These injuries occur due to direct trauma or fall onto outstretched arm. As the forearm is basically a joint, the goal should be anatomical reduction and absolute stability. Treatment is surgical.

Distal radius fractures are covered separately.

Etiology

Direct trauma to forearm, fall from height onto outstretched and pronated forearm, high energy trauma.

Clinical features

Deformity, pain, swelling, loss of function. Neurovascular injuries. Compartment syndrome.

Diagnosis and evaluation

X-ray is usually sufficient. In case of Essex-Lopresti injury there is radio-ulnar dissociation.

Treatment

The forearm is basically a joint, and so the goal of management (as for all joints) should be anatomical reduction and absolute stability. Treatment is almost always surgical with ORIF or OREF.