Incidence and Management of Isolated Radial Shaft Fractures
Isolated radial shaft fractures are more common than Galeazzi fractures (fractures with associated distal radioulnar joint injury) and require careful assessment for associated joint injuries before determining appropriate treatment. 1
Epidemiology and Incidence
While distal radius fractures are extremely common (accounting for approximately 18% of fractures in the elderly and 25% in the pediatric population), isolated radial shaft fractures are less frequently discussed in the literature 2. The annual incidence of distal radius fractures exceeds 640,000 cases in the United States alone, with a bimodal distribution affecting younger (<18 years) and older (>65 years) populations most frequently 2.
Regarding isolated radial shaft fractures specifically:
- They occur more commonly than previously thought
- They are more frequent than true Galeazzi fractures (radial shaft fracture with distal radioulnar joint dislocation) 1
- They have distinct management considerations compared to both-bone forearm fractures
Mechanism of Injury
The most common mechanisms for radial shaft fractures include:
- Falls onto an outstretched hand 3
- Direct blows to the forearm
- High-energy trauma (motor vehicle accidents, sports injuries)
- Gunshot wounds in some cases 4
Diagnostic Approach
Diagnosis requires:
- Standard radiographs (AP and lateral views of the entire forearm including wrist and elbow joints)
- Careful assessment for associated injuries, particularly:
- Distal radioulnar joint (DRUJ) injury
- Proximal radioulnar joint injury
- Essex-Lopresti lesion (radial head fracture with interosseous membrane disruption)
If initial imaging is negative but clinical suspicion remains high:
- Consider splinting and repeat radiography in 7-14 days 3
- Advanced imaging (CT/MRI) may be necessary in complex cases
Management Algorithm
Assessment Phase
- Determine if fracture is displaced or non-displaced
- Evaluate for DRUJ instability (>5mm ulnar-positive variance on radiographs) 1
- Assess for other associated injuries
Treatment Options
For Non-Displaced or Minimally Displaced Fractures:
- Conservative management with immobilization
- Rigid immobilization is preferred over removable splints 2
- Monitor with serial radiographs for 3 weeks and at the end of immobilization 2
For Displaced Fractures:
- Open reduction and internal fixation (ORIF) is the gold standard 5
- Surgical approaches:
- Lateral approach: Provides good exposure to middle third of radius with less risk to neurovascular structures 5
- Volar approach: Requires careful protection of radial artery
- Dorsal approach: Requires protection of posterior interosseous nerve
Surgical Technique:
- 3.5mm limited contact dynamic compression plate (LC-DCP) or locking compression plate (LCP) 5
- Bone grafting may be necessary in comminuted fractures or delayed unions 5
Post-Treatment Management
- For surgically treated patients without DRUJ injury: Early mobilization (within 2 weeks) 1
- For patients with DRUJ injury: Either temporary pinning/immobilization or surgical fixation of large ulnar styloid fractures 1
- Regular follow-up with radiographic assessment until union
Expected Outcomes
When properly managed:
- Union rates are high (100% reported in some series) 5, 1
- Mean time to union: approximately 17 weeks 5
- Functional outcomes are generally good to excellent 5
Potential Complications
- Delayed union or nonunion
- Malunion
- DRUJ dysfunction if associated injury is missed
- Radioulnar synostosis
- Hardware-related complications
- Neurovascular injury during surgical approaches
Clinical Pearls and Pitfalls
- Critical Pitfall: Failing to assess for DRUJ injury in isolated radial shaft fractures
- Important Note: Surgeons should carefully evaluate both the distal and proximal radioulnar joints in all isolated radial shaft fractures 1
- Management Key: Fractures without identifiable radioulnar disruption can be treated without specific DRUJ treatment and with immediate mobilization 1
- Surgical Approach: The lateral approach to the radius offers a simpler approach with lower operative complexity and fewer complications for middle-third fractures 5