Synopsis
Treat the radius and ulna as a linked functional ring, recognise Monteggia and Galeazzi fracture-dislocations, document nerve and vessel status, and restore length, rotation and joint congruence.
- Examine and image the whole forearm including elbow and wrist; a paired-bone ring injury is missed when images stop at the fracture.
- Trace the radiocapitellar line on every elbow view: it should pass through the capitellum, and loss of alignment suggests radial-head dislocation.
- Monteggia is an ulnar fracture or plastic deformity with radial-head dislocation; Galeazzi is a radial-shaft fracture with distal radioulnar-joint disruption.
Key red flags
Escalating pain, tense compartments, passive finger stretch pain or progressive weakness and paraesthesia requires immediate compartment assessment and decompression when diagnosed.
Painful deformity, shortening and loss of pronation or supination follow substantial forearm trauma.
Investigation priorities
Show both bones and include elbow and wrist for linked joint injury.
Management branches
A forearm fracture or deformity follows trauma.
- Expose from shoulder to fingers, remove rings and inspect wounds and compartments.
- Record named nerves and pulses and provide analgesia, alignment and a padded splint.
Remodelling and stable closed treatment are appropriate.
Key medicines
Paracetamol for adult forearm painAn adult may take 500 mg to 1 g orally when needed, never repeating before 4 hours and never exceeding 4 g across 24 hours.
Intravenous open-fracture prophylaxisGive the network-approved intravenous agent and dose as soon as possible and within 1 hour, adjusted for allergy, renal function and contamination.