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My 12-year-old grandson is having surgery for a broken arm. Guess he managed to snap both bones in the forearm in half. My son (his father) said the decision to do surgery was a long time in coming with several orthopedic surgeons consulting. I'm in another state and can't be there. Don't feel like I can ask too many questions when they are already so stressed. What can you tell me about this problem? Why so much hemming and hawing?
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A forearm shaft fracture is a break in the middle of the two long bones in the forearm (radius and ulna). A simple fracture without displacement (separation of the bones) can be successfully treated with cast immobilization. But displacement and angulation (bones shift and are no longer straight but instead form a V- or angular-shape) may be severe enough to require surgery.
Although there are some guidelines about treating a problem like this, each and every patient must be considered individually. Treatment should be customized based on patient factors and surgeon opinion. There may be some aspects of the break the parents haven't shared with you that are challenging and require the careful consultation and planning that is going on.
Making the decision to perform surgery is just the beginning of the process. Now the surgeon must decide whether to use fixation on one or both bones and what type of fixation to use. The two most commonly considered options are a metal plate or a long nail down the shaft of the bone (called intramedullary fixation or IM).
Choice of fixation device goes hand-in-hand with type of procedure: open or closed reduction. As the names suggest, an open reduction means the surgeon makes an incision to open the arm. A closed procedure is done through the skin (percutaneously) or other minimally invasive approach.
Follow-up treatment involves post-operative care selecting either a long or short arm case, length of time in the cast, and if/when to remove the hardware after healing is complete. Removing fixation devices too soon can cause failure to heal and even loss of reduction and reangulation.
Surgeons are encouraged to reduce the bone that is easiest first. If it looks like a toss-up between the two bones, then the straighter bone (the ulna) is reduced first. The surgeons will likely discuss how and where to insert the nail for best results when intramedullary nailing is the treatment choice.
Failure to gain access down the middle of the bone with the nail is a possibility. Repeated efforts to accomplish the task can result in significant soft tissue damage. At that point, the surgeon should switch to an open reduction procedure.Planning ahead for every possibility and discussing these things with other surgeons provides ideas and the benefit of others' experience.
Perhaps when it's all over, you will be able to ask some additional questions. Hopefully, the information here will help you know what questions you might like to pose.
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*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. |
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