A broken forearm, known in medicine as a forearm fracture, affects one or both of the forearm bones: the ulna and the radius. If a forearm fracture is severely displaced, is comminuted or is accompanied by soft tissue injuries, surgical treatment is required to restore arm stability and function. Various materials, such as screws, plates or external fixation, are used to stabilise the fracture.
Overview of forearm fractures
Forearm fractures are among the most common of all bone fractures. The most common cause is external force, usually caused by a fall on the hand or forearm. Older people with bone loss (osteoporosis) are at higher risk and sometimes break their forearm even at low strain. Simple forearm fractures that are not displaced and do not have any bone fragments or soft tissue injuries can be treated conservatively. Displaced fractures, open fractures or comminuted fractures, on the other hand, are treated with surgery.
In the event of a forearm fracture, both or just one of the forearm bones may be broken. In the latter case, we speak of a radius fracture or an ulna fracture.
In medicine, a forearm fracture is also categorised according to where the bone is broken. The most common occurrence is a fracture of the radius near the wrist, often referred to colloquially as a ‘broken wrist’. Strictly speaking, however, it is not the joint itself that is fractured, but the distal end of the radius (distal radius fracture). The distal radius fracture is not only the most common forearm fracture, but is also one of the most common bone fractures of all. Fractures in the middle of the forearm (diaphyseal fractures) or near the elbow (proximal fractures) are less common.
Fractures near the wrist (distal radius fractures) and involving the wrist are explained in the page on surgery for wrist fractures.
Treatment goal
The aim of surgical treatments for a forearm fracture is to restore the original bone position. To ensure that the wrist and elbow are not affected, forearm fractures must be held in exactly the right position until they heal, which is often only possible through surgical fixation of the fracture. The fixation has a significant impact on preventing later mobility restrictions, misalignments or arthritic changes.
Depending on the location and type of fracture, different osteosynthesis methods are used.
Surgical procedure
Depending on the individual situation and general condition of the patient, treatment is carried out either under general anaesthesia or local anaesthesia. With local anaesthesia, the affected arm is specifically anaesthetised, during which the patients are usually given a sedative and often fall asleep during the intervention.
Which fixation method and which materials are used depends on the location and type of fracture. Possible options include percutaneous screw fixation, plate fixation or external fixation.
Percutaneous screw fixation
The percutaneous screw fixation is used for fractures with a large fragment. The fracture is first straightened using small skin incisions and under fluorescent control; a guide wire (Kirschner wire) is drilled into the bone fracture in the desired position. Finally, a bone screw is then screwed in over the guide wire and the wire is removed. On average, two to three screws are necessary for stable fixation of the fracture.
Plate fixation
If the fracture consists of several bone fragments, these are usually fixated with a titanium plate. First, the fragments are brought into the correct position with a wire. Then a titanium plate is placed on the forearm bone and screwed to the stable parts of the bone and the fragments. After being screwed, the wires can be removed again.
If the bones in the fracture area are too badly damaged or there is too little bone substance available, a bone transfer is occasionally carried out. This involves removing bone – usually from the pelvic bone – and transferring it to the fracture area.
External fixation
In case of severe injury to the soft tissues (skin, muscle), the fracture is often fixed from the outside with an external fixator. In this method, screws and metal pins are inserted into the bone above and below the fracture. The metal pins protrude out of the arm and are fixed outside the skin with a rod. This creates a stable frame that secures the broken bone.
Preparation and precautions
Before surgical treatment, a comprehensive examination is carried out, supplemented by imaging techniques such as X-rays in order to accurately assess the injury. Depending on the type and severity of the fracture, the appropriate surgical method is then determined. The usual preoperative clarifications are also carried out, including a blood test, blood pressure measurement and an ECG. If blood-thinning medications are taken, they must be stopped in good time in consultation with the doctor. In addition, it is important that the patient has an empty stomach before the procedure, i.e. they should not eat solid food for at least six hours before the surgery and only drink clear fluids such as water or unsweetened tea until two hours before the procedure.
Aftercare and recovery
Depending on the procedure used, the surgery can be performed on an outpatient basis or may require a hospital stay of a few days. The affected arm must be immobilised for about one month with a splint or plaster cast. Heavy strain should be avoided until it heals completely, which usually takes six to eight weeks.
The healing process depends largely on the type of fracture, the quality of the bones and the patient’s general state of health. In most cases, surgically treated forearm fractures heal faster and more reliably than conservatively treated fractures. In order to maintain the mobility of the joints and promote the healing process, passive mobility exercises are started at an early stage, which are supported by follow-up treatment of targeted physiotherapy.
After a percutaneous screw fixation, removal of the inserted material is usually necessary after three to four months. Titanium plates, on the other hand, can remain in the body permanently as long as they do not cause discomfort.
Potential complications
The surgical treatment of forearm fractures is usually uncomplicated. Nevertheless, as with any surgical intervention, in rare cases complications such as infections, nerve injuries, secondary bleeding or blood clots can occur. In exceptional cases, bone healing can be delayed, leading to what is known as pseudarthrosis (false joint formation). Complex regional pain syndromes such as Sudeck’s atrophy can also develop. Children are also at risk of bone growth disorders, especially if the fracture affects the growth plate.
