Our forearm is mainly made up of two bones, one is the ulna and another one is the radius. These two forearm bones work closely together and there are high risks that both the bones can be injured in some accidents. The radius and ulna fracture of the forearm are characterized by closed, displaced, angulated or open according to their position or location. In an open fracture, the bones are exposed as the skin is torn off, whereas closed fractures do not expose bone but may injure soft tissue like tendon, muscle, nerve, ligament, or artery. A displaced fracture usually leads to overlapping of radius or ulna, whereas an angulated fracture causes abnormal alignment of the two broken bone parts. Fractures are also seen to be comminuted or outward or backward position of the hand with respect to the wrist. A Closed Radius/Ulna Fracture happens when the radius or ulna bone breaks either partially or completely but is not exposed through the skin.
What is Closed Radius/Ulna Fracture?
Closed radius/ulna fracture is the breakage of one of the two or both the bones of the forearm right near wrist joint. The radius bone is located along the thumb side of the forearm, whereas the ulna is aligned with the side of the little finger of the hand.
The breakage can occur near the wrist joint, elbow joint, or in the middle of the bone. Although the radius/ulna both can fracture alone, however, most commonly the two bones use to break together mainly because of impact injury from an accident, fall due to an outstretched arm, or from a direct blow.
Symptoms of Closed Radius/Ulna Fracture
In many cases of a broken radius/ulna bones, the wrist gets deformed or sometimes hangs oddly. Because both bones are generally involved, forearm may appear shorter and bent away from the other arm. You usually need to support the injured forearm with the other hand.
Additional symptoms that are observed are:
- Intermediate pain
- Incapability to rotate or very limited motion of forearm.
- Loss of normal motion of the forearm.
- Weakness or numbness in the fingers or wrist of the broken forearm or in the whole hand.
- Deformity of the injured arm.
- Shortening of the arm if broken pieces of fractured bone are separated apart.
Prognosis of Closed Radius/Ulna Fracture
The prognosis for adults with closed radius and ulna fracture depends on many factors such as choice of treatment method, soft-tissue handling, the timing of internal fixation in open fractures, and restoration of osseous anatomy.
Overall, it can be said that the prognosis is also excellent for most open or closed radius/ulna fractures. In most cases of the patients, the broken bones heal successfully through proper treatment. Most of the patients also recapture complete range of motion and strength in the injured arm after following post-treatment rehabilitation. For most fractures of the radius or ulna bones either open or closed, the post-treatment outlook is very progressive mainly in children or even in adults below the age of 35 years.
Causes of Closed Radius/Ulna Fracture
The most common causes of a closed radius/ulna fracture are described as following:
- Osteoporosis can result in minor fracture of radius or ulna through relative fall.
- In people with above 60 years of age, radial/ulna fractures can occur due to a fall from a standing position.
- Healthy forearm bones can also break if the trauma is severe enough like in the case of an automobile accident or falling from a motorbike.
- Other causes of forearm bones breakage in adults include: fall off from some height or during sports or trauma due to a direct blow.
- Some activities of the children can potentially lead to a fracture of the forearm bones mainly due to an unexpected fall occurring directly on the forearm, onto an outstretched arm or due to a direct blow.
Risk Factors of Closed Radius/Ulna Fracture
Mostly radius or ulna fractures occur in aged postmenopausal women. Generally, females are more prone to get open or closed radius/ulna fractures than males as per female to male ratio of 4:1. Family history of any bone fracture or osteoporosis also increases the risk mainly due to high fragility of the bones. Individuals who smoke more have a high risk of radius or ulna fractures as the smoking habit reduces bone mineral density. Children and adolescents who are active in sports or have an earlier incidence of forearm bone fracture between the ages of 3 and 15 years also possess a higher risk. Sufficient traumatic fractures can occur in any adults due to vehicle accidents or falling from a significant height and these are more commonly associated with an increased soft tissue injury.
Complications of Closed Radius/Ulna Fracture
Closed radial or ulna fractures can cause additional injury and complications as follows:
- The ends of broken bones are often sharp enough to tear off surrounding nerves or blood vessels.
- Excessive bleeding and swelling just after the injury may result in acute compartment syndrome, a condition in which the swelling detaches blood supply to the forearm. It actually occurs within 24 hours of the injury and causes excessive pain. Compartment syndrome can lead to loss of function or sensation and thus need immediate surgery. In these cases, the skin or muscle coverings are left open to get rid of the pressure and allow blood to flow.
- Common complications after treatment of closed radius/ulna fractures include re-displacement, re-fracture, loss of motion, and forearm stiffness. Factors related to all these complications are the inability to obtain an anatomic reduction at the time of initial treatment, increased initial fracture displacement, and poor cast application as measured by cast index, however, as a result of soft tissue repair, contracture of the interosseous ligament or fibrosis of the interosseous membrane can also happen.
There are also risks associated with post-surgical treatment which includes the following:
- Infection: If it is a crash injury or a secondary one, then the risk of infection is very high with surgery of a radius or ulna fracture.
- Synostosis or Radio-ulna Fusion: This is another very rare complication of healing between the two forearm bones with the help of a bridge bone commonly called as radio-ulna fusion or synostosis. This actually reduces the rotation of forearm bones and sometimes prevents complete movement of the hand.
- Damage to Blood Vessels or Nerves: There can be a minor risk of injury to blood vessels or nerves around the forearm fracture and can lead to numbness or weakness in the forearm.
- Nonunion or Malunion: Surgery does not totally heal up the forearm fracture and error in surgical technique can cause malunion or nonunion of the radius or ulna bones and further surgery may be required.
- Complications after operative treatment also include neuropraxia, hardware irritation particularly from flexible intramedullary nails, delayed union, and tendon rupture.
Diagnosis of Closed Radius/Ulna Fracture
- Physical Examination Technique to Diagnose Closed Radius/Ulna Fracture: It is always crucial that your doctor should know the circumstances of forearm bone injury. After listening to the symptoms as well as the medical history, the doctor can go through some careful investigations. Most people with closed radius/ulna fractures rush to an emergency room for the initial treatment.
- Physicians usually examine skin to find out any cuts or bone fragments breaking through the skin surface and thus creating lacerations. This results in high risk for infection.
- Palpate all around the region of the forearm to determine any sorts of tenderness which may indicate other injuries of breakage of any bone.
- Doctor usually checks pulse rate at the wrist to find out whether there is any obstruction in the blood flow through the forearm and then to hand.
- Check to see if there is any kind of weakness or numbness in hands or wrist. This may occur if the nerves get injured at the time of bone breakage.
- The doctor may also examine your upper arm, shoulder, elbow, or wrist if there is any aching or deformity in these regions of your hand.
- Doctors may also check for swelling or inability to turn or move your forearm.
- Imaging Techniques Used to Diagnose Closed Radius/Ulna Fracture: X-rays are the most widely used imaging technique for diagnosing. X-rays can show whether the bone is broken and if there is any gap between broken bones. X-rays can also reveal how many pieces of broken bone are present at the site of injury. Conventional lateral or AP radiographs can also be done for evaluation purposes. The complication in fractures may need an MRI or CT scans to decide the requirement of surgery or any other treatment is optimum or not. If there is any doubt of any nerve or blood vessel damage, then nerve conduction or vascular studies can also be needed to perform.
Treatment of Closed Radius/Ulna Fracture
Treatment for radius or ulna fractures usually depends on the kind of fracture i.e., either open or closed and the degree of replacement. The doctor will use either of the following treatments or a mixture of both, in order to treat a Closed Radius/Ulna Fracture.
- Nonsurgical Treatment for Closed Radius/Ulna Fracture: For stable radius or ulna bone fractures or more severe cases, the doctor generally manipulates or just pushes the bones gently into its place without any surgery. This procedure is termed as closed reduction. Afterward, the arm is immobilized in a cast or splint till it heals.
- Surgical Treatment for Closed Radius/Ulna Fracture: In cases of surgery, the broken pieces of bone are aligned properly and secured in their correct place. Surgery is opted, if:
- There is a high risk for infection.
- The forearm bone fracture is unstable and the ends of the broken bones are not in a line.
Fractures of both the radius and the ulna bone needs to be repaired with plates and screws if:
- Bone segments are displaced.
- The bones cannot be aligned correctly only via manipulation.
- The bones have already started healing at an improper position or making some angular situation.
Surgery usually involves opening up of the skin and relocation of the broken bone fragments through a procedure known as open reduction. Your doctor may use pins, metal implants, plates, screws or a cast to hold the broken bones in place until they heal up appropriately.
Prevention of Closed Radius/Ulna Fracture
Strategies to increase bone strength and prevent age-related bone fracture includes the following:
- Different weight-bearing exercise.
- Preventive measures for and adequate treatment for osteoporosis or osteoarthritis.
- Calcium and Vitamin D supplements.
- The use of protective gear like wrist or elbow guards to prevent forearm bone fracture during sporting activities, such as skateboarders, mountain biking, rollerblades, and skating.
- Therapeutic or preventive medications.
Recovery Period for Closed Radius/Ulna Fracture
Complete recovery from radius or ulna fracture is to be expected within a year or more. For the first year, pain always accompanies any vigorous activities. Some sort of residual stiffness or aching persists with patients above 50 years of age or having osteoporosis or osteoarthritis. However, minor stiffness usually remains for all patients and does not affect the normal function of the forearm. One must take additional care to prevent any further injuries or blow to the same area as they are prone to breakage.