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FOREARM FRACTURES
Forearm fractures are caused by direct trauma or by a fall
on the outstretched arm with an accompanying rotatory or twisting
force.
Evaluation
The forearm is swollen and tender, with limited motion. Evaluate
vascular function by checking pulse, capillary refill and skin
temperature of the hand. Check sensory and motor function of
the radial, median and ulnar nerves. X-rays confirm the nature
of the fracture.
Monteggia fractures involve the proximal ulna with dislocation
of the radial head, usually in the anterior direction (Figure
18.25).
Galeazzi fractures are the reverse of the above, with a fracture
of the distal radius and a dislocation of the radial-ulnar
joint at the wrist. The radius fracture is usually oblique,
causing the bone to shorten (Figure 18.26).
Treatment
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Midshaft
fractures may involve one or both bones; treat single
bone fractures with minimal displacement in a long
arm cast, with the elbow at 90 degrees and the forearm
in neutral rotation |
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Treat
displaced fractures by closed reduction and application
of a long arm splint; perform the reduction by applying
traction to the fingers and manipulating the forearm
with the elbow bent to 90 degrees. Apply counter-traction
above the bent elbow (Figure 18.27) |
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Reduce
Monteggia fractures as described for displaced fractures
(Figure 18.28). Apply a long arm cast in supination.
It is possible to obtain a satisfactory reduction
in children, but adults often require surgical treatment. |
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Treat
Galeazzi fractures as described for midshaft fractures.
They are unstable and often need surgical stabilization. |
Rehabilitation
Begin motion out of the cast at 6–8 weeks.
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