![]() Maximal radial bow is located at position ‘a’. These structures have the potential to be damaged with forearm trauma and are at particular risk when only one forearm bone is broken.įigure 25.1 Illustration showing measurement of radial bow. The proximal radioulnar joint is stabilized by the annular ligament, while the distal radioulnar joint is stabilized by the triangular fibrocartilage complex (the dorsal and volar radioulnar ligaments in particular), the wrist capsule and the interosseous ligament (perhaps a distal band in particular). Computed tomography (CT) scans may be used on occasion to evaluate radioulnar joint alignment. Radiographs are usually sufficient for the evaluation of diaphyseal forearm fractures. Examination of the surrounding soft tissues is important not only to rule out concurrent acute issues such as compartment syndrome but also to judge appropriate timing for surgical intervention. It is also important to check the neurovascular status of the limb by documenting pulses and neurologic function distal to the injury. When only one forearm bone is fractured, evaluate the proximal and distal radioulnar joints. Look for skin lacerations indicating an open fracture. As with any skeletal injury, physical examination should include the entire extremity, paying particular attention to the joints and soft tissues as well as the bone. Individual fractures of the radius or ulnar may be less obvious. ![]() 3ĭiaphyseal fractures of both forearm bones are usually obvious due to the inherent instability created by the injury. reported an incidence of forearm diaphyseal fractures ranging from no fractures to 4.3 fractures per 10,000 population per year ( Table 25.1). 2 Among various categories of patients grouped by age and sex in patients aged 60 or greater, Singer et al. 2 Court-Brown and Caesar studied a population of over 5900 fractures and noted a prevalence of 24% in individuals over 50 years of age, 13% in those over 65 years of age and 12% in those over 75 years of age. The average age of an adult with a forearm fracture is 35 years. 1 The incidence and prevalence of diaphyseal forearm fractures decrease with age. Complications such as infection, nerve damage, malunion and nonunion from operative treatment are uncommon.ĭiaphyseal fractures of the forearm usually result from an axial load applied to the forearm through the hand. Bone grafting is not necessary when comminution is bridged and periosteal and muscle attachments are preserved. It is not clear that intramedullary nailing can accurately restore the radial bow and control rotation in comminuted fractures. In the elderly, a locked plate might be useful when the plate extends into the metaphysis. Stabilization with plates and screws enhances union, provides better alignment, allows immediate functional use of the arm and is safe for most open fractures. Most fractures are treated operatively, especially if both the ulna and the radius are fractured. JUPITERĭiaphyseal forearm fractures are uncommon in the elderly.
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