Fractures of shaft of radius and ulna occurs following substantial trauma . They are quite common fractures in adults. They are also common in children but the fractures in children would be discussed elsewhere.
Clinical Presentation
In adults it is very rare for these fractures to be undisplaced. As radius and ulna are strong bones, an injury of sufficient force is required to break them. This force is good enough to cause displacement.
The patient usually presents with history of significant trauma which results in pain, swelling, deformity and loss of associated function of the forearm. Oftent the displacement is significant enough to make a clinical diagnosis. Level of the deformity or level of tenderness in case of undisplaced fractures tells about the level of the fracture.
Presence of wound is likely to make the fracture open. Therefore any wound especially near the fracture site should be examined for communication with fracture hematoma. A careful neurologic evaluation of the motor and sensory functions of the radial, median, and ulnar nerves should be done. Amount Distal pulses should be palpated to check for vascular status of the forearm.
Swelling of the forearm should assessed to rule out compartment syndrome. A simple clinical test to diagnose a compartment syndrome is passive stretch of the fingers. If pain in the forearm is present when the fingers are passively extended, a compartment syndrome is probably present.
If the patient is noncooperative or unconscious, compartment pressures should be measured to rule out the possibility of compartment syndrome.
Radiography
A simple anteroposterior and lateral radiograph of the forearm would help to diagnose the fracture pattern and the level of the fracture. Wrsit and elbow joints should be included in the radiographs to rule out any associated injury.
The configuration of midshaft fractures of the radius and ulna varies depending on the mechanism of injury and the degree of violence involved.
Low-energy fractures tend to be transverse or short oblique, whereas high-energy injuries are comminuted or segmented and are often associated with extensive soft tissue injuries.
A line drawn through the radial shaft, neck, and head should pass through the center of the capitellum on any radiographic view of the elbow. This simple test can determine any associated elbow injury.
In case of doubtful wrist and elbow injuries computed axial tomography can be undertaken to look for subtle injuries. It is better to involve the normal part of the opposite limb for comparison.
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