Forearm Fractures – Complications

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

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