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Both Bone Forearm Frx: Post Op Care

- Assessment of Reduction:
    - amount of radial bow is determined by drawing a line from the biciptial tuberosity to the ulnar aspect of the distal radius;
    - at the point of maximal radial bow, measure the distance of a line drawn perpendicular to the first line;

- Frx Malunion:
    - corrective osteotomy may be indicated for a combination of the following situations;
          - loss of motion;
          - proximal RU joint arthrosis;
          - distal RU joint instability;
          - symptoms which appear in the first year following surgery;
    - malalignment:
          - its essential to preservation interosseous space;
          - any deviation of radius and ulna toward each other will encroach on the interosseous space;
                 - result is narrowing or obliteration of interosseous space, & marked restriction or loss of rotation of the forearm;
                 - overreduction (increasing radial bow) is also associated w/ poor results;
          - 10-deg angulatory deformity results in 18% loss of pronation-supination, & 15-deg angulatory deformity resulted in 27% loss of forearm rotation;
          - angulation > 20 deg, or any rotational deformity, significantly impaired forearm rotation;
          - deformity at mid-shaft is more limiting than distal forearm deformity;
          - references:
                 - The effect of malunion on functional outcome after plate fixation of fractures of both bones of the forearm in adults.
                 - The effect on supination-pronation of angular malalignment of fractures of both bones of the forearm.

- Non Union:
      - Ununited Diaphyseal Forearm Fractures with Segmental Defects: Plate Fixation and Autogenous Cancellous Bone-Grafting.
      - Double-barrel free fibula flap for treatment of infected nonunion of both forearm bones.

- Plate Removal:
    - refracture may occur thru unhealed frx site if plate is removed prematurely;
    - plates should be retained for at least 18-21 months to allow bone density to return to its prefrx level before removal of plates;
    - forearm should be protected for six weeks following removal;
    - risk factors for frx:
           - frx w/ initial comminution;
           - plating w/ 4.5-mm DCP;
           - early plate removal;
    - references:
           - Refracture of bones of the forearm after plate removal.
           - Refracture of bones of the forearm after the removal of compression plates
           - Year Book: Refractures After Forearm Plate Removal

Cross-union complicating fracture of the forearm. Part I: Adults.

Infected nonunions of diaphyseal fractures of the forearm