(See also Overview of Fractures Overview of Fractures A fracture is a break in a bone. Most fractures result from a single, significant force applied to normal bone. In addition to fractures, musculoskeletal injuries include Joint dislocations... read more .)
Fractures of the radius and ulna are frequently caused by direct blows to the forearm (eg, during contact sports, falls, or defensive actions during an assault). Concomitant dislocations can result from forces transmitted via the interosseous membrane between the radius and ulna.
Pearls & Pitfalls
Isolated midshaft radius or midshaft ulna fractures are common.
Monteggia fractures are proximal ulnar fractures with a radial head dislocation.
Galeazzi fractures are distal radial shaft fractures with a dislocation of the distal radioulnar joint.
Symptoms and Signs
Radial and ulnar shaft fractures can cause pain, deformity, ecchymosis, and swelling at the site of injury.
Anteroposterior and lateral x-rays
Radial and ulnar shaft fractures are generally diagnosed with anteroposterior and lateral x-rays. If a fracture is suspected, the elbow and wrist should also be examined and, when appropriate, x-rayed.
The radial head dislocation is easy to overlook in Monteggia fractures because the fracture is so obvious and should be specifically considered if a proximal ulnar fracture is identified. The radial head is typically visible outside of its normal articulation with the capitellum (capitulum). In Monteggia fractures, the radiocapitellar line also is not aligned correctly, suggesting dislocation (see figure Anterior humeral line and radiocapitellar line Anterior humeral line and radiocapitellar line Distal humeral fractures usually result from a fall on an outstretched arm or direct force; they may be associated with neurovascular injury. (See also Overview of Fractures.) Distal humeral... read more ). In Galeazzi fractures (similar to Monteggia fractures), the distal radioulnar dislocation is easy to overlook with distal radial shaft fractures and should be specifically considered.
For isolated radial and ulnar shaft fractures, closed reduction and splinting with outpatient orthopedic followup
For Monteggia and Galeazzi injuries, urgent orthopedic consultation and usually open reduction with internal fixation (ORIF)
Most isolated radial and ulnar shaft fractures can be treated with closed reduction and splinting with subsequent orthopedic referral.
For Monteggia and Galeazzi fractures, urgent orthopedic consultation is required, and ORIF is usually necessary to maintain alignment.
Radial and ulnar fractures commonly result from direct forces to the forearm.
Take anteroposterior and lateral x-rays.
For isolated midshaft radial or ulnar fractures, always consider concomitant dislocations involving the wrist and elbow.
Treat with closed reduction and consult orthopedics.