What is the treatment for a both bone forearm fracture?

Treatment of Both Bone Forearm Fractures

Open reduction and internal fixation (ORIF) is the recommended treatment for both bone forearm fractures to ensure anatomical reduction and optimal functional outcomes. 1

Initial Evaluation

• Obtain standard radiographic views (posteroanterior, lateral, and oblique) to properly evaluate fracture pattern and displacement 1
• Consider CT scans for complex fracture patterns to identify displacement and fragment positions 1
• Assess for:
  • Open fractures (require emergent referral) 2
  • Neurovascular injury (requires emergent referral) 2
  • Joint instability or dislocation (requires emergent referral) 2

Treatment Algorithm

1. Surgical Management (Primary Treatment)

For most both bone forearm fractures:

• Anatomical reduction of fracture fragments under direct visualization with fluoroscopic verification 1
• ORIF with plate fixation for both radius and ulna fractures 3
  • Provides superior stability and allows early range of motion
  • Ensures restoration of forearm rotation and function

Timing considerations:

• Early surgical intervention (within 24 hours) is recommended to reduce risk of complications such as fat embolism syndrome 4
• For unstable patients or those with severe respiratory compromise, multidisciplinary discussion should determine if external fixation is preferable as initial treatment 4

2. Conservative Management

Limited to specific cases:

• Minimally displaced fractures (<10 degrees angulation) 1
• Stable fracture patterns 1
• Patients who are poor surgical candidates

Conservative approach includes:

• PRICE protocol (protection, rest, ice, elevation) - compression should be avoided in acute setting 2
• Immobilization with short arm cast or functional forearm brace 2
• Regular radiographic follow-up to ensure maintenance of reduction

Post-Treatment Management

Pain Management

• Multimodal analgesia approach recommended 4
• NSAIDs for pain and inflammation control 1
• Consider benefit/risk ratio based on patient's volume status and muscle damage 4

Rehabilitation

• Early finger motion exercises to prevent stiffness and edema 1
• Progressive rehabilitation protocol once immobilization is discontinued
• Home exercise program can be as effective as supervised therapy for uncomplicated cases 1

Expected Outcomes and Complications

Expected outcomes after ORIF:

• High union rates (typically 8-10 weeks) 5
• Near-normal restoration of anatomy and motion 3
• Moderate reduction in strength compared to uninjured arm:
  • Forearm pronation (70% of normal) 3
  • Forearm supination (68% of normal) 3
  • Grip strength (75% of normal) 3

Potential complications:

• Joint stiffness and limited range of motion 1
• Chronic pain 1
• Post-traumatic arthritis 1
• Hardware-related issues 1
• Infection (increases risk of non-union and poor functional outcomes) 6

Special Considerations

• Pediatric patients: Consider intramedullary nailing as an alternative to ORIF, though both have higher complication rates than closed treatment when applicable 5
• Segmental bone loss: May require corticocancellous iliac bone grafting with plate fixation 6
• Elderly patients: Evaluate for osteoporosis and consider calcium/vitamin D supplementation 1
• Smokers: Advise smoking cessation as it increases nonunion rates and leads to inferior outcomes 1

Follow-up Care

• Regular assessment of wound healing and radiographic union 1
• Monitor for hardware-related pain or complications 1
• Ensure compliance with rehabilitation protocols 1
• Consider secondary fracture prevention strategies for fragility fractures 1