What is a forearm fracture?
A forearm fracture is a term for a break in the ulna and or radius bones in the forearm. The end of the forearm closest to the body forms the elbow joint and the furthest away point articulates with the carpal bones of the wrist. The Elbow joint itself is formed by the union of the far end of the humerus (the upper arm bone) and the radius and ulna (the forearm bones). The end of the ulna known as the olecranon process (the boney point at the back of your elbow) hooks into the back of the humerus creating what is known as a hinge joint named as such as it only moves in flexion and extension. The two forearm bones run parallel to each other however the radius is slightly smaller and shorter in length. If you hold your forearm palm facing upwards then the ulna will be running up the inside of your forearm (closest to your body) and the radius will be on the outside always connecting to the wrist at the side of the thumb. The radius and ulna play an important role in the movement of the forearm and hand as it is the joints between the radius and ulna at the top and the bottom of the forearm that allow you to pivot your hand and forearm from palm upwards to palm downwards, actions known as supination and pronation. Although it is possible to fracture any portion of both bones the most commonly affected area is the wrist known as a distal fracture, it is also quite common to fracture both the radius and the ulna at the same time. Middle fractures occur along the long bone shaft were as proximal fractures occur close to the elbow. A Monteggia fracture is classed as a proximal fracture as it affects the ulna close to the elbow and causes the dislocation of the radial head. An Olecranon fracture and a radial head fracture are two types of fractures specific to the proximal area of the forearm bones and may be classed as an elbow fracture. A fracture to the radius is sometimes known as a Colles’ fracture, although if there is also a dislocation of the radial connection to the carpal bones in the wrist then it is classed as a Barton fracture.
Why & when does a forearm fracture happen?
Forearm fractures are very common in both the older and younger population and are normally the result of a crush trauma like a car accident or high impact from falling onto an outstretched hand. It is instinctive to put your hands out to save yourself when you fall but this means that your wrist and arm impact the hard floor with your body weight behind it which in many cases is too much strain for the thin forearm bones to bear. Falling backwards and landing on your elbow also causes enough strain to fracture the tip of the olecranon. The injury is often seen in athletic sports where falls are common such as cycling, running, ice skating, skateboarding and snowboarding but it is more commonly seen in the very young and very elderly as falls are more common at these ages. Minor injuries like mild falls and mild knocks to the forearm can result in a forearm fracture, this typically only happens when there is an underlying bone weakening condition like osteoporosis. Forearm fractures are classified into closed fractures where there is no injury to the skin of the forearm and open fractures where there is an open wound as a result of the fracture. Due to the risk of damage to the surrounding arteries, nerves and tendons forearm fractures are considered a medical emergency.
What to do if a forearm fracture is suspected after trauma?
If you suspect someone has sustained a forearm fracture after any type of trauma then you must immediately call for medical help. As mentioned previously most people injured by high impact accidents may have sustained other injuries as well as the fracture making medical attention vital. It is important to make sure the individual is safe and comfortable If the patient is otherwise unharmed it may be advisable to escort them to A&E if there is the possibility of other injuries then it is advisable to wait for medical help. On arrival paramedics will check the patient over, stabilise the arm, normally with a sling before taking the patient to accident and emergency.
What does a forearm fracture feel like?
A forearm fracture from trauma causes a very intense immediate sharp pain around the fracture site this pain can radiate up into the upper arm, elbow and down into the wrist and hand. The fracture is often accompanied by swelling and bruising and aggravated by most arm or hand movements this makes weight bearing or lifting with the effected hand excruciating. Patients will instinctively cradle their fractured arm in their good one keeping it immobilised and close to their body. The intense pain after a break will last for several hours which will be aggravated or prolonged by any treatment options like manipulation or traction. Post-surgery or after treatment when the bone starts to heal there will be a dull continuous ache from the swelling and healing process that will last weeks to months. During the healing process the bone is trying to knit together and re-unite this stage can be quite painful and it is very important to rest through this stage to ensure that the bone reconnects properly. The soft tissue surrounding the fracture also starts to form scar tissue to bind everything together allowing the structure to try and restore its original state and function.
How will a forearm fracture be diagnosed?
Patients will be taken to A&E and a full examination will be done to rule out any additional injuries or complications like nerve damage or infection. Your doctor will order an X-ray of the forearm to confirm the diagnosis and identify the location and the extent of the fracture. Occasionally if the extent of the fracture isn’t fully visible on an X-ray then an MRI or a CT scan will be ordered as this will give a more detailed view of the fractured site. Doctors will also use an MRI scan to assess whether the pain felt after trauma is coming from injury to the forearm muscles, ligaments or joint capsules and not indeed from a fracture. The occurrence of a forearm fracture from mild trauma may prompt doctors to investigate for any underlying bone weakening conditions.
What treatment options are available for forearm fractures?
The treatment options and healing times for forearm fractures varies depending on the position and severity of the fracture and also on the complications from any additional injuries like infection with open fractures. Most cases of forearm fractures do not need surgery however it is occasionally necessary to surgically stabilise multiple fractures or some severe complete breaks. Traction or manipulation may be used to correct the position of the fractured bone and a splint or a cast will be used to reinforce and stabilise the fracture until it is well healed. Patients will initially have to rest and avoid weight bearing or lifting with that arm whilst recovering. The doctor will most likely prescribe anti-inflammatory medication and painkillers for pain relief and to reduce any swelling. A forearm fracture can take anything from 8 -12 weeks to heal if not longer for more severe breaks. Patients will be referred through to a physiotherapist who will provide exercises to strengthen upper arm and forearm muscles to aid the healing process. Fluctuating pain levels will be experienced throughout the healing process however most of the discomfort towards the end of the healing process comes from stiffness levels caused by long term immobility. The rehabilitation exercises as well as massage and some manipulative therapies can aid in recovering your elbow, arm or wrist flexibility.