Both
Bone Forearm Fracture
These
fractures are relatively more common in children than adults because of
differences in diaphyseal bone mechanics. Because of this, both bone forearm
fractures in adults are more likely to be high energy open fractures than
those seen in children. Traditionally, both bone forearm fractures in children
are treated closed much more often than both bone forearm fractures in
adults. In general, complications are more common and prognosis is worse
for displaced fractures and for open fractures. On the average, nondisplaced
fractures take six to eight weeks to heal, and displaced fractures take
three to five months. Satisfactory functional end results may be expected
in about eight out of ten patients with nondisplaced fractures and about
one half of those with displaced fractures. Function may be most obviously
affected with loss of pronation / supination, and as many as half of patients
with both bone forearm fractures will have obv ious loss of forearm pronation,
which may or may not be functionally significant. Loss of forearm rotation
is most likely when fractures occur in the middle third of the forearm.
Synostosis between the radius and ulna is much more common in proximal
than in distal forearm fractures, occurring in about one out of fifteen
patients with proximal fractures. Synostosis is also more likely in children,
with open fractures, with single incision access to both to and forearm
bones, and following high energy injuries. Nonunion occurs in as many as
one out of ten patients. Early protected motion appears to improve the
odds of satisfactory final motion. Internal or external fixation is usually
indicated for open or very unstable fractures, accepting the risk that
postsurgical infection may occur in as many as one out of twenty patients.
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