Midshaft ulna and radius fractures in adults
- Nathaniel Nye, MD
Nathaniel Nye, MD
- Adjunct Assistant Professor of Family Medicine
- Uniformed Services University
- Anthony Beutler, MD
Anthony Beutler, MD
- Associate Professor of Family Medicine
- Uniformed Services University
The hand is a vital structure for a multitude of motor tasks, and the forearm contributes a great deal to the hand's versatility. The forearm allows the hand to interact with objects remote from the body, and enables it to pronate and supinate, capabilities that are essential for many activities of daily living, as well as technical skills such as those required for music and sports. The forearm also plays an important role in protecting the head and torso from trauma, which explains in part why fractures of the forearm are among the most common fractures.
Given the many important roles of the forearm, it is no surprise that forearm fractures can result in considerable disability, especially if treated improperly. The epidemiology, clinical anatomy, assessment, diagnosis, and management of midshaft fractures of the radius and ulna in adults will be reviewed in this topic, including Galeazzi and Monteggia fracture-dislocations. Distal forearm fractures and pediatric midshaft forearm fractures are discussed separately. (See "Distal radius fractures in adults" and "Midshaft forearm fractures in children" and "Proximal fractures of the forearm in children".)
EPIDEMIOLOGY AND RISK FACTORS
Although forearm fractures are relatively common, studies of the epidemiology of diaphyseal fractures of the forearm are scant. The incidence of diaphyseal fracture of the radius, ulna, or both is reported to be approximately 1 to 10 per 10,000 persons per year, although rates vary by age and sex. Studies show a bimodal distribution with the highest incidence among young males aged 10 to 20 years (10:10,000) and females over age 60 (5:10,000) [1-3]. Diaphyseal forearm fractures occur far less frequently than distal forearm fractures [1,2].
Risk factors for diaphyseal forearm fractures include sports participation, postmenopausal status, osteoporosis, and frequent walking on icy surfaces (eg, as occurs in cold climates such as Canada or Sweden) [1,2]. Football and wrestling are the highest-risk sports with 0.48 and 0.21 midshaft forearm fractures per 10,000 high-school athletic exposures, respectively . While postmenopausal status increases the risk for both distal and midshaft forearm fractures, it increases the risk for distal fractures far more (nearly an order of magnitude in some studies) [1,2,5].
Galeazzi fractures (radial midshaft fractures with distal radioulnar joint [DRUJ] instability) account for 7 percent of all forearm fractures. Of all fractures involving only the radial shaft, one in four is a true Galeazzi injury. The less common Monteggia fracture dislocation (fracture of the proximal third of the ulnar shaft with dislocation of the radial head) comprises 1 to 2 percent of all forearm fractures .
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- EPIDEMIOLOGY AND RISK FACTORS
- MECHANISM OF INJURY
- CLINICAL PRESENTATION AND EXAMINATION
- CLASSIFICATION OF MIDSHAFT FOREARM FRACTURES
- Questions for characterizing fractures
- Galeazzi fractures
- Monteggia fractures
- RADIOGRAPHIC FINDINGS
- INDICATIONS FOR ORTHOPEDIC CONSULTATION OR REFERRAL
- INITIAL TREATMENT AND FOLLOW-UP
- Isolated ulnar shaft (“nightstick”) fracture
- - Initial treatment
- - Definitive treatment
- - Follow-up radiographs
- Isolated radial shaft fracture
- - Initial treatment
- Galeazzi fracture-dislocations
- - Initial treatment
- Combined radius and ulna (both-bone) fractures
- - Non-operative treatment
- - Operative treatment
- Monteggia fracture-dislocations
- RETURN TO SPORT OR WORK
- SUMMARY AND RECOMMENDATIONS