Forearm: Radius and ulna shaft fractures

In adults, fractures of the radius and ulna shaft with any displacements should be treated with anatomic reduction and stable surgical fixation.

Whereas growing children with a similar fracture can self correct even large amounts of deformity, in adults minimal loss of radial bow can result in significant loss of motion of the forearm.

How is this surgery done?

  1. The surgery actually consists of two separate surgeries, one for the radius, the other for the ulna.
  2. The surgical incision for the radius is in front of the foream. The radius is typically approached through the Henry interval. It usually is necessary to detach part of the pronator teres, FDS, and a little supinator muscle from the radius in order to make space for the metal plate.
  3. The surgical incision for the ulna is in the back of the forearm. The ulna is just under the skin, and this part of the surgery therefore is simpler.
  4. For each bone, a metal plate is placed besides the fracture, and screws are inserted into the bone above and below the break.

What are the risks of this surgery?

  1. Death from anesthesia, and perioperative complications such as heart attack, stroke, etc.
  2. Infection, as with any other surgery
  3. Plate or screw breakage, loosening, etc.
  4. Nerve damage, muscle damage, etc.

Nevertheless, surgical treatment is absolutely the correct treatment for displaced fratures of the radius and ulna in adults.

What is the typical recovery?

  1. In the best case scenario, these fractures can be declared healed 2 months after surgery. Therefore it is necessary to have regular follow up and repeat xrays.
  2. Physical therapy is necessary in order to obtain full motion and strength.
  3. While the bones are healing, it is important to avoid strenuous activities. In theory, when a metal plate is used to stabilize a broken bone, it is always a race between the hardware breaking and the bone healing.

Case study

A 25 year old male fell violently on ice. He presented with a large amount of swelling of the forearm, with deformity, and severe pain.

After surgery, cast was not necessary and early range of motion was started. Whereas early motion must be started, any strenuous activity such as pulling, pushing, weight lifting, etc., must be avoided.

Staples were removed 2 weeks surgery, at which point the range of motion was also almost fully normal.

Here are the xrays at 4 months after surgery. Both fractures look good, the patient has a strong hand grip, full motion, and is pain free.