RADIAL AND ULNAR SHAFTS
Fractures of the shaft of the bones of the forearm occur most frequently in children. The radius or the ulna may be fractured at any level. Frequently, displacement occurs when both bones are broken. The forearm’s unique functions of pronation and supination must be preserved with good anatomic position and alignment.
If the fragments are not displaced, the fracture is treated by closed reduction with a long arm cast applied from the upper arm to the proximal palmar crease. A loop may be incorporated in the cast near the elbow and a sling pulled through it to prevent the cast from sagging against the forearm.
The circulation, motion, and sensation of the hand are assessed after the cast is applied. The arm is elevated to control edema. Fre-quent finger flexion and extension are encouraged to reduce edema. Active motion of the involved shoulder is essential. The reduction and alignment are monitored closely by x-rays to ensure ade-quate immobilization. The fracture is immobilized for about 12 weeks; during the last 6 weeks, the arm may be in a functional forearm brace that allows exercise of the wrist and elbow. Lifting and twisting are avoided.
Displaced fractures are managed by open reduction with inter-nal fixation, using a compression plate with screws, intramedullary nails, or rods. The arm is usually immobilized in a plaster splint or cast. Open fractures may be managed with external fixation de-vices. The arm is elevated to control swelling. Neurovascular sta-tus is monitored. Elbow, wrist, and hand exercises are begun as permitted by the immobilization device.
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