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Forearm Fractures

The forearm consists of two bones, the radius and the ulna.  Forearm fractures are usually significant injuries that lead to pain, stiffness and deformity.  In adults and teenagers, forearm fractures usually require surgical fixation.  The best way to fix forearm fractures in an adult or teenager 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 to facilitate healing.  Bone graft can be obtained through a small incision over the wrist or the elbow, and usually does not cause any significant additional pain.  This is different than it used to be when surgeons routinely harvested bone graft from the iliac crest above the hip; this was much 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 angled (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, a small plate that avoids the physis (growth plate) may be placed.  Young children may get by with just a pin or two.  Unlike in adults, children are usually casted after surgical fixation.  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 stiff from casting, as adults can.

If skillfully fixed, forearm fractures usually do very well.  An Orthopedic Hand or Upper Extremity Surgeon is usually the most experienced physician for treating these fractures.

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