Authors of section

Authors

Andrew Howard, Theddy Slongo, Peter Schmittenbecher

Executive Editor

James Hunter

General Editor

Fergal Monsell

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Fracture instability and malalignment

1. Introduction

Forearm rotation is the function of the distal and proximal radioulnar joints and forearm fractures should be managed as an articular fracture.

Forearm rotation is essential for many activities and should not be limited following injury.

There are age related differences in remodeling potential and fractures in children under 10 years old may be managed without surgery in some cases.

Limitation of pronation and supination is however unacceptable and eventual function should be as good as expected in adult patients.

Indications for osteosynthesis in pediatric forearm fractures have expanded and have a good evidence base.

fracture instability and malalignment

2. Factors defining stability of forearm fractures

The following fracture patterns are likely to produce suboptimal results:

  • Fractures at the same level
  • Oblique fractures
  • Multifragmentary fractures
  • Converging fragments
  • Proximal shaft fractures

These patterns should be considered during patient and radiological assessment and inform the treatment strategy for an individual patient.

fracture instability and malalignment

X-ray showing a both-bone fracture with fractures at the same level and an oblique fracture of the ulna

fracture instability and malalignment

X-ray showing a multifragmentary fracture

fracture instability and malalignment

X-ray showing converging fragments in a both-bone fracture

fracture instability and malalignment

X-ray of a proximal 1/3 shaft fracture

fracture instability and malalignment

If an unstable fracture heals with deformity, long-term restriction of forearm rotation may result.

fracture instability and malalignment

Full rotational mobility of the forearm is essential for daily and professional activities. Pronation is important for use of keyboards and supination for using a screwdriver.

fracture instability and malalignment

3. Malalignment of other forearm fractures

Some stable fractures including single bone fractures may also result in malalignment; and limited rotation.

fracture instability and malalignment

4. Prevention

Operative treatment of children with unstable forearm fractures may be required to avoid long-term limitation of forearm function.

The following both-bone fracture types are often unstable and require careful supervision and timely operative intervention to prevent malunion:

  • 22-D/2.1 Greenstick
  • 22-D/4.1 + 4.2 Transverse, simple + multifragmentary
  • 22-D/5.1 + 5.2 Oblique or spiral, simple + multifragmentary
fracture instability and malalignment

With appropriate treatment, good results ...

fracture instability and malalignment

... with normal forearm function should be expected.

fracture instability and malalignment