MANUAL MINORS
An isolated radial shaft fracture involves a break in the midportion of the radius without affecting the ulna. This fracture often results from falls onto an outstretched hand or direct blows to the forearm. Depending on the severity, it may be a simple fracture or a comminuted fracture (with multiple fragments). Symptoms include localised pain in the middle of the forearm, swelling, and difficulty moving the wrist and elbow.
Diagnosis
Diagnosis is made through a physical examination, where tenderness over the radius, deformity, or swelling in the affected area is noted. Anteroposterior and lateral X-rays of the forearm confirm the fracture and help assess the alignment and type of fracture (transverse, oblique, or comminuted). In some cases, a CT scan may be required for complex fractures.
Differential Diagnosis
Condition | Distinctive Characteristics |
|---|---|
Fracture of both forearm bones | Fractures of both the radius and ulna, with generalised pain throughout the forearm. |
Galeazzi fracture | Fracture of the distal radius with dislocation of the distal radioulnar joint. |
Monteggia fracture | Ulna fracture with dislocation of the radial head, affecting the elbow. |
Wrist sprain | Localised pain in the wrist without evidence of fracture on X-rays. |
Emergency Management
In the emergency setting, the affected forearm should be immobilised with a splint to prevent further displacement of bone fragments. Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) are used for pain control. If the fracture is displaced, immediate reduction under sedation may be required, though this is usually reserved for severe cases.
Definitive Treatment
Treatment depends on the stability of the fracture. Non-displaced fractures can be managed conservatively with immobilisation in a cast for 4 to 6 weeks. Displaced, unstable, or comminuted fractures generally require surgery with open reduction and internal fixation using plates and screws. After treatment, physiotherapy is necessary to restore function, strength, and mobility to the forearm.
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