Forearm: Radius: Isolated radial shaft fractures

With isolated radial shaft fractures, the concern is that there may be an unrecognized ulna fracture as well, or that the proximal or distal radioulnar joint may be disrupted.

Can these fractures be treated with a cast?

As with most forearm shaft fractures, in adult patients surgery is virtually always the best treatment.

In children and adolescents, some deformity can be tolerated depending on the age of the patient, fracture pattern, and surgeon experience.

How is the surgery done?

  1. The incision to get to the radius is usually in front of the forearm. 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.
  2. The surgery involves placement of a plate and screws on the fractured radius.
  3. Fluoroscopy xrays are used during surgery to determine appropriate position of the fracture and metal plate.

What are some of the risks of this surgery?

  1. Death from general anesthesia complications such as stroke, heart attack, etc.
  2. Nerve or vessel damage
  3. Loss of fixation with breakage or loosening of screws, etc.

A couple of examples are shown below

Case 1, treated without surgery

This was a 15+6 male, approaching skeletal maturity, with an isolated distal radial fracture, sustained during a football tackle.

The elbow and wrist joints were not tender. Xrays of the elbow and wrist showed no involvement of either joint.

This patient was treated with a cast for 6 weeks.

Below are xrays at 3 months after the injury.

The patient had stiffness in pronation and supination when the cast was removed. The stiffness improved with physical therapy, and he regained full motion by 6 months.

Case 2

This was a 25 year old male who presented after an altercation and fall.

Unclear whether an impact on the forearm, or the fall was the case of the injury.

No neuromotor deficit was seen.

Both elbow and wrist were not tender. This suggested no Monteggia or Galeazzi type injury.

Xrays of the elbow and wrist were reassuring in that respect.

As for many orthopedic injuries, surgical treatment is superior provided one avoids infection. For this particular injury in this skeletally mature patient, surgical treatment is without a doubt the correct treatment.

Reduction required substantial traction, as expected, because the ulna is not fractured, and the proximal and distal radioulnar joints are intact. The ulna essentially keeps the radius short.

After surgery, the patient progressed well. He was pain free at the 2 week appointment, and he was deemed healed and returened to work as a line cook by 3 months. He came to clinic for a last check 1 month after returning to work.

Here are the xrays of the healed fracture at 4 months after surgery.