Treatment of Fractures of Radius and Ulna

Fractures of radius and ulna can be treated with various options. These vary from cast immobilization, plate fixation, intramedullary nailing to external fixation with each of them having an appropriate indication.

The basic principle behind the treatment is accurate anatomic reduction, rigid fixation, and early mobilization of the soft tissues.
Majority  of  displaced fractures of the shafts of the radius and ulna are treated by operative method. Closed treatment of displaced fractures of the radius and ulna  should be undertaken only if there is a specific contraindication to operative treatment. Nondisplaced fractures of the shafts of both the radius and the ulna are very rare in adults.

Note the proximal position of the loop. Image has been taken from Journal of bone and joint surgery from an article by knight & Purvis

Cast Immobilization
Simple cast immobilization is used in undisplaced fracture of both bones of the forearm in adults. However this entity is very rare in adults. A well -molded, long-arm cast is applied in these rare subtypes,  extending  from the axilla to the midpalm, with forearm in neutral pronation-supination and the elbow flexed to 90 degrees. A collar and cuff sling is applied  and the sling is passed through the loop proximal to or at the fracture site.

This position of the loop is important.  If the sling is attached to the cast distal to the level of the fractures, the cast may sag in this area as atrophy of the proximal forearm muscles occurs. Distally there is less soft tissue, so the forearm bones are still held firmly by the cast resulting in angulation.

however, if the loop is proximal, it keeps  the cast firmly against the ulna when suspended from neck by sling [see image].

Following cast application, xrays should be done at weekly interval. It is very common for these fractures to become displaced later, therefore  they should be watched. In case the displacement occurs,  it should be treated as displaced fracture.

Closed Reduction and Cast Immobilization

Displaced fractures of forearm do not yield satisfactory results with closed treatment. The results are  not certain,  immobilization required is too long, and there is increased risk of stiffness of the elbow and forearm. Operative methods yeild much better results.

Operative Treatment

Open reduction and internal Fixation using plate fixation is the standard treatment for closed, displaced fractures of forearm. these fractures of both bones of the adult should be fixed as soon as feasible preferably within the first 24 to 48 hours of injury because the fractures lying in liquid hematoma are easier to reduce and fix.

But these fractures should be fixed any time irrespective of the delay for whatsoever reason. We at our institution have fixed fractures as old as 6 mionths and they show good results inspite of delayed fixation.

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3. Xray of Distal End Of Radius And Ulna In 9 Years Old Child
4. Fracture of Distal Third Of Radius And Ulna
5. Fracture of Shaft Radius And Ulna At The Same Level – Anteroposterior Xray