Dr. Ebraheim’s educational animated video describes complications of forearm fractures.
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Radius & Ulnar Shaft Fracture Complications
The patient had open reduction and internal fixation of the midshaft radius fracture. The patient has full range of motion and no tenderness, and the fracture healed. You should reassure the patient and do occasional follow up examinations. If there is plate irritation, then you will remove the plate, and you may get a refracture. Removal of the plate should not occur before twelve months. Some physicians delay removal of the plate until two years post injury. After implant removal, the forearm should be splinted for six weeks to decrease the chance of refracture. Diaphyseal plate removal from the forearm carries a high risk of refracture for that bone. Refracture may occur after implant removal. Refracture occurs in about 5-10% following both bone fractures. The refracture can happen through the original fracture or through the screw holes. If refracture occurs, then the treatment should be open reduction and internal fixation. When the fracture is comminuted or 4.5 screws are used initially. Heterotopic ossification (HO), which is bony bridging myositis. Bone bridging between the radius and the ulna that restricts rotation. Early excision is done 4-6 months after surgery. Traditionally, it used to be 12 months, but nowadays it is done earlier. When you fix the radius and the ulna, it is better to do a dual incision rather than a single incision. Synostosis can occur as a complication from one incision to both bones. Avoid the one incision approach to both bones. In compartment syndrome of the forearm, the patient will have pain with passive stretch of the digits. When there is pain with passive stretch of the digits, the physician should be concerned about an impending or established compartment syndrome. The physician should avoid multiple attempts at reduction of the fracture. The treatment of compartment syndrome is forearm fasciotomy.
