Challenge of the Week / Trauma / 10.18.19

A 35-year-old male patient who is right-hand dominant and works as an accountant is seen in the emergency department with closed radial and ulnar shaft fractures. He has insulin-dependent diabetes-mellitus and his current HbA1c is 5.8%. The radial fracture is comminuted and has 5 mm of displacement, but is not shortened. The ulnar shaft fracture has no comminution. The elbow and wrist joints are reduced and well-aligned. Which of the following would be the appropriate definitive management for this patient’s fractures?
  • Closed reduction with percutaneous intramedullary fixation of both fractures
  • While intramedullary fixation may be indicated in children, it is generally not indicated in adults.

  • Short-arm cast
  • A short arm cast is not indicated for displaced both bone forearm fractures in adults, as it will neither correct malalignment nor provide sufficient stability.

  • Long-arm cast
  • A long-arm cast is not indicated for both bone forearm fractures in adults, as it would result in unnecessary elbow and wrist stiffness.

  • Open reduction and internal fixation with plate fixation of both bones
  • Optimal treatment to maximize functional outcome in both bone forearm fractures in adults aims to restore length, rotation, alignment and the interosseous space. Open reduction and stable plate fixation allows for this, as well as allowing early mobilization and rehabilitation.

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