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DR.JAMAL AL-SAIDY
M.B.CH.B…F.I.C.M.S
FRACTURE OF A SINGLE FOREARM BONE
Fracture of the radius alone is very rare and fracture of the ulna alone is uncommon.
These injuries are usually caused by a direct blow – the ‘nightstick fracture’.
They are important because of : An associated dislocation may be undiagnosed; if only
one forearm bone is broken along its shaft and there is displacement, then either the
proximal or the distal radio-ulnar joint must be dislocated. The entire forearm, elbow and
wrist should always be x-rayed.
Clinical features
Ulnar fractures are easily missed – even on x-ray. If there is local tenderness, a further x-
ray a week or two later is wise.
X-ray
The fracture may be anywhere in the radius or ulna.
The fracture line is transverse and displacement is slight. In children, the intact
bone sometimes bends without actually breaking (‘plastic deformation’).
Treatment
Isolated fracture of the ulna The fracture is rarely displaced; a forearm brace leaving the
elbow free can be sufficient.
However, it takes about 8 weeks before full activity can be resumed.
Rigid internal fixation will allow earlier activity and avoids the risk of displacement or
non-union.
Isolated fracture of the radius Radius fractures are prone to rotary displacement; to
achieve reduction in children the forearm needs to be:
supinated for upper third fractures,
neutral for middle third fractures and
pronated for lower third fractures.
The position is sometimes difficult to hold in children and just about impossible in adults;
if so, then internal fixation with a compression plate and screws in adults, and preferably
intramedullary rods in children, is better.
Middle/distal third fractures of the radius in children These are particularly unstable,
being deformed by the pull of the thumb abductors and pronator quadratus. They can be
treated with an above-elbow cast in supination but, failing that, fixation with an
intramedullary rod, Kirschner (K-) wires or a plate is advisable.
THANK YOU
DR.JAMAL AL-SAIDY
M.B.CH.B..…… F.I.C.M.S