This type of fracture ranks second among forearm fractures, second only to distal radius fractures. It can result in lateral displacement, overlap, rotation, or angular deformity, making treatment relatively complex. Different forms of trauma lead to different types of fractures: A. Direct violence: Commonly seen in cases of strikes or machine injuries, the fracture is transverse or comminuted, with the fracture line lying in the same plane. B. Indirect violence: When falling with the palm landing on the ground, the force travels upward, causing a fracture in the middle or upper third of the radius. The residual force transmits obliquely downward through the interosseous membrane to the ulna, resulting in a fracture of the ulna. Thus, the ulna fracture line is lower than that of the radius. The radius fracture is usually transverse or serrated, while the ulna fracture tends to be short and oblique. C. Torsional violence: When falling with the body tilting to one side, the forearm is subjected to both longitudinal transmission and rotational torque, leading to a spiral fracture of both the radius and ulna. The fracture lines run in the same direction, often extending from the medial-upper part of the ulna to the lateral-lower part of the radius.

bubble_chart Clinical Manifestations

Local swelling, deformity, and tenderness may be present, with possible bone crepitus and abnormal movement, accompanied by restricted forearm motion. Children often present with greenstick fractures, displaying angular deformity without displacement of the bone ends. Occasionally, median nerve, ulnar nerve, or radial nerve injuries may occur, necessitating careful examination.

Pain and limited movement after forearm trauma; X-rays can determine the type of fracture and degree of displacement. Imaging should include the elbow and wrist joints to assess for rotational displacement and dislocation of the proximal or distal radioulnar joints.

bubble_chart Treatment Measures

1. Reduction is difficult, with high requirements, and displacement is prone to occur after reduction.

(1) Children with greenstick fractures often have angular deformities, which can be corrected under appropriate anesthesia by gentle manual traction and fixed with a cast for 6 to 8 weeks. A cast wedge incision can also be used to correct the angular deformity.

(2) For displaced fractures, first perform longitudinal traction to correct overlap and angular deformities. Under continuous traction, if the fracture is in the upper 1/3 (above the insertion of the pronator teres), the forearm should be placed in a supinated position; for fractures in the middle and lower 1/3 (below the insertion of the pronator teres), the forearm should be placed in a neutral rotation position to correct rotational deformities. Then, apply compression at the fracture site to separate the bones, restoring the tension of the interosseous membrane and the normal gap, and finally achieve complete alignment of the fracture ends. After reduction, fix with a long-arm cast for 8 to 12 weeks. The cast should be immediately incised and loosened after molding. During fixation, monitor the distal circulation to prevent ischemic contracture. Adjust the tightness of the external fixation promptly after swelling subsides, and observe and correct any re-displacement of the fracture.

This is suitable for cases where manual reduction fails or fixation is difficult after reduction; multiple fractures in the upper limb with interosseous membrane rupture; open fractures with short injury duration and mild contamination; or cases of nonunion or malunion with limited function.