based on the location in the forearm (proximal, middle or distal 1/3)
Treatment
Children
CR/POP
note the deforming forces of muscles at different levels of fracture
Can accept 1cm overriding as long as the bones are correctly aligned & rotated
Can accept up to 20° angulation at the fracture in the skeletally immature (ie less than 10 years)
no significant loss of pronation or supination providing the rotation of the individual bones is correct
Correction of angulation has been reported up to 18o (Larsen, 1988) mainly due to change in the orientation of the epiphyseal plate & appositional bone formation & resorption If close to cessation of growth require an anatomical reductio
ORIF if unable to obtain or maintain reduction
Adults
ORIF
Prognosis
ORIF of 330 acute fracture ‘s of radius & ulna – 97% union
Anderson etal ” Compression plate Fixation in acute Diaphyseal fracture ‘s of the radius & ulna”
JBJS 57A: 287- 296, 1975
Complications
Nonunion: 3%
Malunion: rare in ORIF
Infection: ~ 3%
Refracture after R/O metal
Cross union: ~ 1-2 %
typically follows severe local trauma & delayed ORIF of fractures at the same level.
Multiple trauma & head injuries are also associated & can occur despite the use of separate incisions
Cross unions should be excised between the first & second year after the fracture & bone scans showing quiescence of activity of callus may be useful in determining when to perform surgery
