MANUAL MINORS
Fractures of the shaft of the radius and ulna affect the mid-portion of both bones in the forearm. These fractures typically result from direct trauma, such as falls, car accidents, or direct blows.
They can be simple fractures (single line) or complex, such as comminuted fractures (multiple fragments). Symptoms include intense pain, visible deformity, inability to move the forearm, and sometimes nerve or blood vessel damage.
Diagnosis
Diagnosis is based on a physical examination, which may reveal deformity, swelling, and difficulty with movement. X-rays of the forearm in both frontal and lateral views are essential to confirm the type of fracture, its location, and the degree of displacement. In some cases, a CT scan may be required to better evaluate comminuted or complex fractures.
Differential Diagnosis
Condition | Distinctive Characteristics |
|---|---|
Monteggia fracture | Ulna fracture with dislocation of the radial head. |
Galeazzi fracture | Radius fracture with dislocation of the distal radioulnar joint. |
Distal radius fracture | Involves the distal end of the radius, with pain and swelling near the wrist. |
Wrist sprain | Pain and swelling without visible fractures on X-rays. |
Emergency Management
Initial management includes immobilising the forearm with a splint or cast to prevent further displacement of bone fragments and protect neurovascular structures. Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) are used to relieve pain.
In cases of open fractures, antibiotics and tetanus prophylaxis should be administered. Urgent reduction under anaesthesia may be required if the fracture is significantly displaced or affects circulation.
Definitive Treatment
Definitive treatment depends on the type and stability of the fracture. Non-displaced fractures may be treated with immobilisation in a cast for 6 to 8 weeks. Displaced, unstable, or comminuted fractures generally require open reduction and internal fixation with plates and screws. Physiotherapy is essential after treatment to restore range of motion, strength, and function of the forearm.
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