The forearm consists of two bones, the radius and the ulna. Forearm fractures are usually signicant injuries that lead to pain, stiffness and deformity. If the forearm bones are broken in an adult, surgical fixation is usually required. The best way to fix forearm fractures in an adult is with strong plates and screws. This is an outpatient procedure and is very effective. If the bones are in more than two pieces, bone graft may be required. Bone graft can be obtained through a small incision over the wrist or the elbow, and usually does not add any significant pain to the operative experience. This is different than it used to be when surgeons routinely harvested iliac crest bone graft from the area above the hip; this was more painful, especially using older, more invasive techniques.
Forearm fractures should be fixed in a timely fashion, within 2-3 weeks of the injury. If the forearm bones are allowed to remain in a displaced position (ie. bent or shortened) for a long period of time, scarring can increase the difficulty and complication rate of the surgery and decrease final motion, especially forearm rotation.
Following surgery, if the bone quality is good, early motion can usually be started after 4-5 days. It is very important to regain forearm rotation, as that is the most common motion that is lost.
In children, forearm fractures can often be treated without surgery. However, if the broken fragments of bone are too angled (bent) or shortened, surgery may be required. In older children, 10 years of age or greater, a small plate that avoids the physis (growth plate) may be placed. Unlike in adults, children are usually casted. That is because the smaller plates used in children are weaker than those used in adults, and need protection until the fracture is healed, which usually takes 6 weeks. Children do not usually become as stiff as adults.
If skillfully fixed, forearm fractures usually do very well. An orthopaedic hand or upper extremity specialist is usually the most experienced in treating these fractures.