Overview
Adult forearm fractures are typically caused by a direct blow, fall on an outstretched arm, or automobile and motorcycle accidents. Most patients will need to seek immediate treatment. In adult forearm fractures, both the radius and ulna of the forearm can be broken. The forearm’s primary function is rotating our palms up and down. The radius rotates around the ulna as it remains still. When the forearm is fractured, it affects your ability to rotate your arm, bend, and straighten your wrist and elbow as well.
Forearm fractures can break the bone in different ways. Your bone can slightly break or break into many pieces. These broken fragments of bone may line up straight, be far out of alignment, and in some cases, may stick out through your skin. Open fractures require immediate attention due to the risk of infection.
Typically, during a forearm injury, a strong force will break both the radius and ulna in the middle of the bone; however, if one bone is broken, it is typically the ulna as it is the bone outside of your arm used to shield direct blows. Forearm fractures may cause other ligaments at either the elbow or wrist to tear causing joint dislocation.
A broken forearm usually causes immediate pain and a noticeable deformity, where your forearm appears bent or shorter than your uninjured forearm. Other symptoms include bruising, swelling, inability to rotate your arm, and numbness in your fingers.
Forearm and Elbow
In adult forearm fractures, both the radius and ulna of the forearm can be broken. The forearm’s primary function is rotating our palms up and down.
Treatment
Dr. Stowell will ask the circumstance of your injury to identify if you sustained any other injuries from it. He will ask about your medical history and what medications you are taking. After discussing your symptoms, Dr. Stowell will carefully examine your skin to see if any bone fragments have broken through your skin. He will feel for tenderness around your arm and may examine your shoulder and upper arm even if your main complaint is arm pain to determine if there are other broken bones or injuries. He will check your wrist pulse to be sure that there is good blood flow to your hand. He will also check your fingers and wrist to determine if there is any nerve damage.
Dr. Stowell will order X-rays to determine whether the bone is broken or displaced and see if there are any broken pieces of bone.
Treatment of broken bones follows a basic rule: put the broken pieces back into position and prevent them from moving out of place until they are healed. For immediate attention, Dr. Stowell may attempt to temporarily realign the bones, a process called reduction. To relieve pain, he may apply ice to help reduce swelling and suggest medication. He may also apply a splint to your forearm for stabilization. In a broken forearm, the radius and ulna need to be properly stabilized since they rely on each other for support; otherwise, future problems may result in elbow and wrist movement.
It is critical to stabilize a broken bone because moving a broken bone can cause further damage to blood vessels, nerves, or other tissues surrounding the bone as well as result in significant pain.
Surgical treatment
In adult forearm fractures, surgery is common to make sure the bones are aligned and stabilized for successful healing. When both the radius and ulna are broken or if you have an open fracture, surgery is usually required. Open fractures demand surgery more urgently because of the increased risk for infection. You may be given antibiotics and a tetanus shot. During surgery, Dr. Stowell will thoroughly clean the cuts from your injury and fix the broken bones. In severe open fractures, multiple operations may be necessary to clean the injured soft tissue more thoroughly.
If your skin has not been broken around your fracture, Dr. Stowell may wait until swelling has gone down before recommending surgery. Swelling will decrease when keeping your arm elevated above your heart for several days.
There are several surgical repair options for forearm fractures:
- Open reduction and internal fixation with plates and screws – Dr. Stowell repositions the bone fragments into their normal alignment and the bones are held together with special metal plates and screws to the outer surface of the bone.
- Open reduction and internal fixation with rods – Dr. Stowell inserts a special metal rod through the marrow space in the center of the bone.
- External fixation – in severe cases, Dr. Stowell may treat your fracture with an external fixator where he places metal pins into the bone above and below the fracture site. The pins and screws attach to a bar outside your skin.
Plates and screws are usually left in place forever. If you would like to remove them, the surgery to do so is scheduled once your bones have fully solidified.
Complications
Complications exist for both non-surgical and surgical treatments of adult forearm fractures including:
- Tearing of surrounding blood vessels or nerves due to the sharpness of the broken bone fragments.
- Excessive bleeding and swelling that leads to compartment syndrome, a condition that cuts off blood supply to the hand and forearm due to swelling. Compartment syndrome requires emergency surgery once diagnosed so that the skin and muscle coverings are exposed and left open to relieve pressure and help the return of blood flow.
- Bone infection may occur even with good surgical cleaning. It often requires multiple surgery and long-term antibiotics.
- Synostosis, a rare complication where a bridge of bone forms that heals between the two bones of the forearm, decreasing the rotation of the bones and preventing full movement.
- Nonunion may occur if the fracture fails to heal. Surgery does not guarantee healing of the fracture.
- Plates, screws, or rods may shift or break due to the patient’s lack of following directions after surgery or other health conditions that slow healing like diabetes or smoking.
- Stiffness and inability to fully rotate your palm up and down.
- Cumbersome or painful implants from plates placed on bones during surgery.
Recovery
Forearm bones typically take 3 to 6 months to fully heal; however, the more severe your injury, the longer it may take to recover. Dr. Stowell will work with you to reduce pain. He may prescribe short-term pain relief options and minimize the need for opioids.
Physical therapy will help with rehabilitation. With nonsurgical treatment of a forearm fracture, after a few weeks being in a cast or brace, Dr. Stowell may recommend physical therapy to help increase range of motion and strengthen your arm. After surgical treatment, the length of time in a cast or brace may be 2 to 6 weeks, so gentle early motion will help prevent stiffness. Dr. Stowell may prescribe visits to the physical therapist to help move along your rehabilitation.