Patient Information Resources


Orthopedic Services
Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale, CA 91206
Ph: (818) 409-8000






Ankle
Elbow
Foot
Fractures
General
Hand
Hip
Knee
Pain Management
Shoulder
Wrist

View Web RX

« Back

What Happens Years After Forearm Fractures?

Posted on: 11/30/1999
Fractures of both bones of the forearm in children who have not yet reached skeletal maturity (full bone growth) versus children, teens, and adults who have reached full growth are the subject of this long-term study. This group of patients have been followed from the time of the acute injury through short-term, mid-term, and now long-term periods.

The specific type of forearm fracture under investigation is referred to as a diaphyseal fracture of the forearm. The diaphyseal part is the shaft of the long bone. In the forearm, there are two long bones: the radius and the ulna.

There were 71 patients in the study divided into two groups: those who were skeletally mature and anyone who had not reach full bone growth (skeletally immature). The groups were also analyzed based on different treatment approaches used.

The cause of fractures varied but included car accidents, falls, fireworks explosion, crush injuries, and industrial accidents. Slightly less than half of the total group had other injuries as a result of the trauma. There were other bones broken and/or nerves damaged.

Everyone was followed for an average of 21 years. The range of years in terms of follow-up was from 13 to 33 years. Age range at the time of follow-up was from 19 years old up to 81 years old. Exact ages at the time of the fractures were not mentioned in this article but from the information provided, there were children, teens, and some adults.

Treatment was either with a cast (immobilization) or surgery. Surgery consisted of making an incision, straightening the bones, and holding them in place with a metal plate and screws. The surgical procedure is called open reduction and internal fixation (ORIF).

A few patients had external fixation without an open incision. External fixation means that pins are placed through the skin above and below the fracture site. There is a metal rod between the two pin sites.

Some of the patients who were treated first with cast immobilization or external fixation eventually had to convert to an open reduction and internal fixation (ORIF). There was too much loss of reduction (fractures shifting apart) with the cast or external device.

Results for all patients were measured in terms of wrist, forearm, and elbow motion along with grip strength and function. Symptoms such as pain, tenderness, and stiffness were also measured. X-rays were taken periodically. Patients were evaluated for depression, pain catastrophizing, and disability.

Pain catastrophizing means the person focuses more and more on the experience from a negative point-of-view. The person begins to fear moving as it might lead to pain or reinjury. The result can be disuse of the affected body part, disability, depression, and chronic pain.

Catastrophizing or expecting the worst to happen increases pain. Catastrophizing boosts anxiety and worry. These emotions stimulate neural systems that produce increased sensitivity to pain. It can become a vicious cycle.

And, in fact, in this study they found that catastrophizing was a better predictor of long-term results than whether the patient had reached skeletal maturity or not. In fact, pain catastrophizing and misinterpreting pain were better predictors of outcome than motion or function. Grip strength was also an important red flag predicting disability.

There were some complications after treatment. Some occurred early on while others were reported years later. The most common problem was loss of reduction (already mentioned). After that were wound infections (especially along the pins holding the bones in place), and osteomyelitis (bone infection).

Delayed bone healing, nonunion (failure of bone to knit back together), and refracture of the bones are other post-treatment problems that can develop. One patient developed a syndrome of symptoms (pain, stiffness, skin changes) diagnosed as complex regional pain syndrome.

The data from this study represent one of the few long-term studies (more than 10 years) following diaphyseal fractures of both bones in the forearm. The conclusion so far is that bone age (mature or immature) doesn't determine complications or long-term results. Impairment, loss of function, and disability seem to be linked more closely with psychosocial factors and illness behaviors (catastrophizing, depression).

The authors made no suggestions or recommendations based on these results. Clinical implications (i.e., how this information affects treatment) have yet to be determined. The fact that results were so similar regardless of age at the time of the fractures is a new piece of information to be studied further.

References:
Arjan G. J. Bot, et al. Long-Term Outcomes of Fractures of Both Bones of the Forearm. In The Journal of Bone and Joint Surgery. March 2011. Vol. 93. No. 6. Pp. 527-532.

« Back





*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.


All content provided by eORTHOPOD® is a registered trademark of Mosaic Medical Group, L.L.C.. Content is the sole property of Mosaic Medical Group, LLC and used herein by permission.