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Fracture of Both Bones of Forearm

Classification

  • based on the location in the forearm (proximal, middle or distal 1/3)

Treatment

Children

  • CR/POP
    • note the deforming forces of muscles at different levels of fracture
    • Can accept 1cm overriding as long as the bones are correctly aligned & rotated
    • Can accept up to 20° angulation at the fracture in the skeletally immature (ie less than 10 years)
    • no significant loss of pronation or supination providing the rotation of the individual bones is correct
    • Correction of angulation has been reported up to 18o (Larsen, 1988) mainly due to change in the orientation of the epiphyseal plate & appositional bone formation & resorption If close to cessation of growth require an anatomical reductio
  • ORIF if unable to obtain or maintain reduction

Adults

  • ORIF

Prognosis

  • ORIF of 330 acute fracture 's of radius & ulna - 97% union
    • Anderson etal " Compression plate Fixation in acute Diaphyseal fracture 's of the radius & ulna"
    • JBJS 57A: 287- 296, 1975

Complications

  • Nonunion: 3%
  • Malunion: rare in ORIF
  • Infection: ~ 3%
  • Refracture after R/O metal
  • Cross union: ~ 1-2 %
    • typically follows severe local trauma & delayed ORIF of fractures at the same level.
    • Multiple trauma & head injuries are also associated & can occur despite the use of separate incisions
    • Cross unions should be excised between the first & second year after the fracture & bone scans showing quiescence of activity of callus may be useful in determining when to perform surgery
  • Nerve damage
    • rare - more common with proximal fracture
  • Compartment syndrome