Edited by Carew Giberson-Chen and Jeffrey "Spud" Olson - 7/1/2021
Descriptors
Fracture location: Radial shaft, ulnar shaft, both bone
Fracture type:
- Simple: spiral, oblique, transverse
- Wedge/butterfly: intact, fragmentary
- Segmental: intact, fragmentary
Fracture characteristics:
- Displacement
- Angulation
Associated injuries:
- Galeazzi: distal 1/3 radial shaft fx + associated DRUJ injury, higher risk of DRUJ instability if fracture <7.5 cm from articular surface
- Monteggia: proximal 1/3 ulnar fx + associated radial head dislocation/instability
- Floating elbow
- Compartment syndrome
Exam Pearls
Upper extremity neurovascular exam
Carefully inspect skin to determine open vs closed
Good assessment of radial and ulnar pulses
Good assessment of median, radial, and ulnar nerve function
Evaluate for compartment syndrome: palpate compartments, NV exam, pain with passive stretch, pain out of proportion; consider Stryker needle if concerned
Workup
Radiographs: AP and lateral forearm XRs, AP and lateral wrist XRs, AP and lateral elbow XRs
Other imaging: XRs usually sufficient
Labs: Pre-op labs (CBC, BMP, T&S, CXR, EKG, UA, covid swab)
Other: Surgical consent, compartment checks
Management
Need for acute intervention: Yes, immobilization without reduction In case of Galeazzi and Monteggia injuries, the DRUJ or radiocapitellar joint should be reduced.
Weight-bearing and range of motion: NWB in splint
Type of immobilization: sugartong splint
Admission or discharge status: Admit for surgery
Anticoagulation: Lovenox 40mg QHS while admitted
Antibiotics: None unless open
Surgical Indications
Absolute: Open fracture Vascular compromise Concern for compartment syndrome
Relative: Forearm fractures are almost always operative unless patient is an unacceptable surgical candidate
Not an indication: None