A fractured forearm can be painful, swollen, tender, and sometimes, even deformed. It can affect your ability to rotate your arm, as well as bend and straighten the wrist and elbow. Untreated forearm fractures can lead to several complications, both immediate and long-term. When a bone fracture is untreated, it can result in either a nonunion or a delayed union. In the former case, the bone doesn’t heal at all, which means that it will remain broken. As a result, swelling, tenderness, and pain will continue to worsen over time. This is why you should not hesitate to contact the caring and experienced orthopedic specialists at OCC – Advanced Orthopedic & Sports Medicine Specialists in Denver, Parker, or Aurora, Colorado.
OVERVIEW
Fractures of the forearm are common injuries in adults accounting for close to half of all broken bones in adults. The highest incidence occurs in men between 10 and 20 years old and women over 60 years old. Fractures of the forearm can occur at different levels: near the wrist at the farthest (distal) end of the bone, in the middle of the forearm, or near the elbow at the top (proximal) end of the bone. They can occur through a direct blow (a fall on the forearm or direct impact from an object) or indirect injury. The latter is usually secondary to landing on an outstretched arm.
ABOUT THE FOREARM
The forearm contains two long bones, the radius and the ulna, that run between the elbow and the wrist joints. If one drops the arms to the side, palms facing outward. The bone closest to the body is the ulna. It’s longer and larger than the forearm’s other bone, the radius. (While maintaining that palms-out position, the radius is closest to the thumb.) The ulna which is straight, is biggest at the elbow, and the radius which has a curve or bow to it, is biggest at the wrist. Together, they give the forearm its rotational flexibility — that’s how it is possible to turn palms up or palms down. The radius and ulna are covered with many long muscles that control the movement of the wrist, hand, and fingers. Several arteries and nerves also pass through the forearm. They provide blood supply and feeling to different parts of the hand and forearm. These nerves also control the actions of the muscles, which allows the use of hands and fingers.
WHAT IS A FOREARM FRACTURE?
The forearm has a complex anatomy to serve its functions of supporting and positioning the hand in space and providing anchorage for muscles that serve hand function. To fully restore these functions after a forearm fracture the bones must heal in the normal anatomical position. Forearm fractures can occur as a single (radius or ulna only) or combined (both bones) fracture. When both bones are fractured at different levels and there is a joint injury at the wrist or elbow, these are described as Galeazzi or Monteggia fractures. A Galeazzi fracture is most often a displaced fracture in the radius and a dislocation of the ulna at the wrist where the radius and ulna come together. A Monteggia fracture is most often a fracture in the ulna and the top (head) of the radius is dislocated at the elbow joint. Occasionally, one bone may break by itself without any other injuries. This usually occurs after a direct blow to the middle of the forearm, and in the ulna, it is sometimes called a “nightstick injury.” Forearm bones can break in several ways. The bone can crack just slightly, or it can break into many pieces. The broken pieces of bone may line up straight or may be far out of place. In some cases, the bone will break in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone. This is called an open fracture and requires immediate medical attention because of the risk of infection.
CAUSES
- Falling onto an outstretched hand or elbow is the most common cause of a forearm fracture
- A direct blow
- Sports injuries—any sport that involves physical contact or increases the risk of falling including football, soccer, gymnastics, skiing, and skateboarding increases the risk
- Significant trauma—a forearm fracture can break during a car accident, bike accident, or other direct trauma
- Conditions that weaken bones, such as osteoporosis and bone tumors, increase the risk of a forearm fracture. This type of break is known as a pathological fracture
SYMPTOMS
Common symptoms of forearm fracture include:
- Severe pain which might increase with movement
- Swelling
- Bruising
- Deformity, such as a bent arm or wrist
- Inability to turn arm from palm up to palm down or vice versa
- Numbness or weakness in the fingers or wrist (rare)
NON-SURGICAL TREATMENT
Treating forearm fractures non-surgically depends on the specific type and severity of the fracture. Overall these are some common more conservative treatments:
Immobilization—casting or splinting is used for less severe fractures where the bones are not displaced
Functional bracing—this involves using a brace that allows limited movement while keeping the bones in proper alignment. This is often used in stable fractures to help maintain muscle strength and joint flexibility during the healing process
Pain management—over-the-counter pain relievers like acetaminophen or NSAIDs such as ibuprofen can both manage pain and reduce inflammation. Applying ice packs can help reduce swelling and alleviate pain, especially in the initial stages following the injury
Activity modification—limiting activities that stress the forearm can prevent further injuries and allow the bone to heal
Physical therapy—once the initial immobilization phase is complete and the bone has begun to heal, physical therapy can help restore strength, flexibility, and range of motion to the affected arm
WHEN IS SURGERY INDICATED?
When both forearm bones are broken, or if the bones have punctured the skin (open fracture), surgery is usually required. Open reduction and internal fixation is the most common type of surgical repair for forearm fractures. During this procedure, the doctor first repositions (reduces) the bone fragments into their normal alignment. The bones are held together with special screws and metal plates attached to the outer surface of the bone. If the skin, muscles, and bone are severely damaged, an external fixation is done. In this type of operation, the doctor places metal pins into the bone above and below the fracture site. The pins and screws are attached to a bar outside the skin. This device is a stabilizing frame that holds the bones in the proper position so they can heal.
GETTING THE RIGHT DIAGNOSIS. GETTING THE RIGHT DOCTOR.
One might think diagnosing and treating a forearm is rather straightforward, however, it is anything but according to the notable orthopedic surgeons at Advanced Orthopedics in Denver, Parker, or Aurora, Colorado. A careful examination will determine if there are any cuts from the injury. Bone fragments can break through the skin and create lacerations which lead to an increased risk for infection. Palpating all around the arm will help determine if any other cases of tenderness can indicate other broken bones or injuries.
A good orthopedic professional will check your pulse at the wrist to be sure good blood is getting through your forearm to your hand. They check to see if you can move your fingers and wrist and can feel things with your finger. Sometimes, nerves may be injured at the same time that the bone is fractured which can result in hand and wrist weakness and numbness. Your doctor may examine your shoulder, upper arm, elbow, wrist, and hand, even if you complain only of arm pain. X-rays are the gold standard for diagnosing forearm fractures and must include views not only of the forearm but the wrist and elbow as well to exclude concomitant injuries. CT or MRI may be employed to assess vascular, neurological, or soft tissue injury. Not all orthopedic doctors are as detailed and thorough and do such extensive exams as the highly capable, and experienced specialists you’ll find at Advanced Orthopedics. They’re who you want if you want your forearms to heal to their normal shape, getting you back to your normal life. Schedule an appointment today.
