When forearm fractures are displaced or bone fragments and soft tissue injuries exist, they are treated surgically. Different materials such as screws, plates or external fixation devices are used to fix these fractures.
There are two bones in the forearm: the radius and the ulna. When someone suffers a forearm fracture, both bones as well as only one of them can break.
Forearm fractures are one of the most common types of fractures. They occur as a result of external force, usually when someone falls on their hand or forearm. Older people with osteoporosis have a higher risk, and sometimes break their forearm even by exerting the slightest force on it.
Simple forearm fractures which are not displaced, show no bone fragments or soft tissue injuries can be conservatively treated. On the other hand, displaced fractures, open fractures or fractures with bone fragments require surgical treatment.
Fractures near the wrist or involving the wrist are explained in the chapter entitled Surgery on wrist fractures.
Forearm fractures must be fixed in the correct position until they heal so that the wrist and the elbow joint are not impacted. This is often only possible with surgical fixation of the fracture.
Depending on the type and location of the fracture, different osteosynthesis procedures are used.
What preparations are carried out before the procedure?
An x-ray examination serves to determine the exact progression of the bone break.
All the usual pre-operative assessments are required, such as a blood test, blood pressure measurement and an ECG. The patient must stop taking blood-thinning medication and have an empty stomach for the procedure.
How is the operation performed?
Depending on the situation and the general condition of the patient, the operation is performed under general anaesthesia or regional anaesthesia. If regional anaesthesia is used, the patients receive a sedative and usually sleep during the operation.
The procedure and the material used to fix the fracture depends on the location and the type of forearm fracture. The operation can be performed on an outpatient basis.
Percutaneous screw fixation
Percutaneous screw fixation is used for breaks with large fragments.
The bone is straightened and a guidewire (Kirschner wire) is also bored into the desired position in the bone fracture via small incisions in the skin and under fluoroscopic imaging. Finally, a bone screw is screwed in and the wire is removed once more. An average of 2 to 3 screws are required for stable fixation of a fracture.
If the fracture consists of multiple bone fragments, they are usually fixed with a titanium plate. Firstly, the fragments are brought into the correct position with a wire. Then a titanium plate is laid on the shoulder bone and screwed onto the stable parts of the bone and onto the bone pieces. Afterwards, the wires can be removed once more.
If the bone in the area of the break is too badly damaged or there is insufficient osteolysis, a bone graft is sometimes undertaken. In the process, bone is usually taken from the pelvis and grafted into the area of the fracture.
In the case of an injury of the soft tissue (skin, muscle), the fracture is often fixed with an external fixation device from the outside. During this method, screws and metal rods are inserted above and below the fracture in the bone. The metal parts protrude from the arm and are fixed outside the skin with a rod. In the process, this produces a stable base which fixes the bone break.
What is the success rate of this procedure?
The healing process for femur fractures depends on the type of fracture, the condition of the bone and the general condition of the patient. Forearm fractures generally heal well after surgical fixation. The healing process is quicker than with conservative treatment. The healing process is hastened with targeted physiotherapy exercises which are started soon after the operation.
What are the possible complications and risks of this procedure?
Surgical treatment of forearm fractures usually proceeds without major complications. As with all surgery, in exceptional cases the operation may lead to infections, nerve damage, post-operative haemorrhaging or blood clots. In rare case, it can lead to a formation of false joints (pseudoarthrosis) or to the development of a regional pain syndrome, Morbus Sudeck. Bone growth can be impaired in children.
What happens after the operation?
Depending on the procedure used, the operation can be conducted in an outpatient clinic or requires a stay of several days in hospital. Exercises are begun early so that the patient retains movement in their joints and fingers. The arm must be immobilised in a plaster cast or a splint for around a month. The patient may not put their full weight on their leg until it has healed fully; this will take approx. 6 to 8 weeks.
After percutaneous screw fixation, the metal must be removed after 3 to 4 months. Titanium plates can be left in the body as long as they do not cause complaints.