Forearm Shaft Fracture Plating

Indications

• Displaced both bone fractures in adults
• Monteggia and Galeazzi injuries
• Isolated displaced radial shaft fractures
• Forearm fractures in adults behave like intra-articular injuries because rotation depends on both bones
• Closed treatment of displaced both bone fractures in adults gives poor results

Position

• Supine, arm table, upper arm tourniquet
• Image intensifier with views of the elbow and wrist

Operative Steps

1. Radius through the volar Henry approach, supinate proximally to protect the posterior interosseous nerve
2. Ulna through the subcutaneous border between ECU and FCU
3. Use separate incisions to reduce synostosis risk
4. Compression plates, at least three bicortical screws each side
5. Restore radial bow for rotation
6. Check DRUJ and radiocapitellar joint stability after fixation
7. Fix the less comminuted bone first to restore length
8. Use 3.5 mm compression plates
9. Bone graft is rarely needed with modern biological plating

Postoperative Care

• Early motion
• Avoid plate removal unless symptomatic because of refracture risk
• Sling and light dressing, with motion from the first days
• Radiographs at 2 and 6 weeks
• Return to heavy work after union at about 3 months

Complications

• Radioulnar synostosis
• Posterior interosseous nerve injury
• Refracture after plate removal
• Compartment syndrome
• Malunion with loss of radial bow limits rotation
• Nonunion is uncommon with compression plating
• Infection

Related Pages

• Adult Fractures of the Forearm & Wrist
• Forearm approaches

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.