OrthoNet

Forearm Fractures - Complications

Malunion
- caused by inadequate follow-up, improper reduction, delayed diagnosis and treatment
- rotational loss is most disabling

If early consolidation but not yet healed - manual osteoclasis and casting
If late consolidation with callus - can try drill osteoclasis and casting
If solidly united - open osteotomy and internal fixation
- get x-rays of other side
- decide exactly what the deformity is - how much angulation, and how much rotation?
- angular malalignment is, in general, easier to correct than rotational
- for late DRUJ pain and instability, can do a Darrach

Refracture
- 12% of cases
- can occur up to one year after

Overgrowth - not an issue

Compartment Syndrome
- be ready to do anterior and posterior fasciotomies
- anterior fasciotomy must decompress carpal tunnel, deep compartment, and release lacertus fibrosis. Also look for compression of NV structures at proximal edge of pronator teres and FDS

Synostosis
- risk increases with repeated manipulations, severe comminution and displacement, surgical trauma, application of onlay bone grafts (with narrowing of the interosseous space), and closed head injury
- can occur with one and two incision techniques
- do not touch until the bone has matured
- excise and interpose fat; excise periosteum too