A fractured forearm is a common orthopedic injury that occurs when one or both of the two long bones in the lower arm break. The forearm is the section of the upper limb situated between the elbow and the wrist, and its integrity is required for complex hand and arm movements.
The Anatomy of Forearm Fractures
The forearm is uniquely structured around two parallel bones: the radius, located on the thumb side, and the ulna, situated on the pinky-finger side. These bones articulate with each other at both the elbow and the wrist, allowing for the rotation of the hand known as pronation and supination. Because of this parallel arrangement and the forces transmitted between them, it is common for a fracture to involve both bones simultaneously, particularly in adults following high-energy trauma.
Fractures are categorized based on which bone is broken and where the break occurs along its length, such as proximal (near the elbow), shaft (middle), or distal (near the wrist). A break can be further classified as non-displaced, where the bone fragments remain in alignment, or displaced, where the fragments have shifted and separated. In children, incomplete breaks like greenstick fractures are common, where one side of the bone breaks and the other side bends.
More complex injuries involve a fracture in one bone combined with a dislocation in one of the adjacent joints. A Monteggia fracture involves a break in the ulna shaft with an accompanying dislocation of the radial head at the elbow. Conversely, a Galeazzi fracture describes a break in the radius shaft combined with a dislocation of the ulna at the wrist joint. These fracture-dislocation patterns are considered inherently unstable because the injury compromises both the bone and the stabilizing ligaments around the joint.
Identifying Symptoms and Seeking Care
A broken forearm typically presents with immediate, intense pain at the site of the injury, often following a fall onto an outstretched arm or a direct blow. The pain is significantly exacerbated by any attempt to move the arm, wrist, or elbow. Swelling and tenderness develop quickly around the fracture area, and bruising may appear shortly after the trauma.
In cases of a displaced fracture, a visible deformity, such as an unnatural bend or shortening of the forearm compared to the uninjured arm, may be apparent. The ability to rotate the forearm, turning the palm up or down, is often severely limited or impossible due to the disruption of the two-bone system. Tingling or numbness in the fingers or hand can be a sign of potential nerve damage or a serious condition called compartment syndrome, which requires immediate medical attention.
Upon presentation to an emergency setting, a physical examination is performed to check for open wounds, circulation, and nerve function. To confirm the diagnosis and determine the precise nature and severity of the fracture, X-rays are routinely used. Imaging pinpoints the exact location of the break, assesses the degree of displacement, and checks for associated joint dislocations before a treatment plan is finalized.
Medical Treatment Options
The management of a forearm fracture is determined by the stability of the break and the alignment of the bone fragments. Non-surgical treatment is typically reserved for stable, non-displaced fractures, or those involving only a single, well-aligned bone. This approach involves a closed reduction, where a doctor manually manipulates the bone pieces back into an acceptable position without surgery.
Once the bones are reduced, a cast or splint is applied to immobilize the forearm and prevent the fragments from shifting while they heal. Non-operative management is closely monitored with frequent follow-up X-rays, especially in the first few weeks, to ensure the fracture maintains its alignment. If the bone fragments slip or the alignment is lost, surgery may become necessary to achieve proper healing.
Most adult forearm fractures, particularly those involving both the radius and ulna or complex patterns like Monteggia and Galeazzi injuries, require surgery. The standard surgical procedure is Open Reduction Internal Fixation (ORIF). During ORIF, the surgeon makes an incision to view the fracture site, realigns the bone fragments, and secures them with internal devices. These fixation devices commonly include metal plates and screws affixed to the outside of the bone, or sometimes rods placed down the center.
The Path to Full Recovery
Following either casting or surgical fixation, the initial period involves immobilization to allow the bone to achieve sufficient union. The typical timeline for bone healing in adults ranges from 6 to 12 weeks, though complete recovery of strength and function takes longer. Fractures requiring surgical intervention often necessitate a recovery period toward the longer end of this range.
Once the initial immobilization period is complete and the surgeon confirms adequate bone healing, physical therapy (PT) becomes necessary. Prolonged immobilization leads to joint stiffness and muscle weakness, which PT is designed to address. A structured rehabilitation program focuses on regaining the full range of motion in the elbow, wrist, and forearm, specifically targeting rotation.
Early mobility exercises, followed by a strengthening phase, are introduced gradually to prevent re-injury or delayed healing. Adherence to the prescribed rehabilitation protocol is essential for restoring coordination and strength, which determines the long-term functional outcome of the arm. Full return to strenuous activities, such as contact sports or heavy manual labor, is typically cleared by a doctor around three to four months after the injury.