Proximal forearm Fracture Discussion

Proximal forearm fractures are associated with a variety of problems, including nonunion, nerve and tendon injuries and synostosis. One fifth to one half of patients can be expected to have significant permanent loss of forearm rotation. Open treatment of acute fracture or nonunion may be complicated by additional nerve injury or synostosis, more likely when injuries are open or classified as high energy. Synostosis, or cross-union between the radius and ulna is much more common in proximal than in distal forearm fractures, occurring in about one out of fifteen patients with proximal fractures. Synostosis is more likely in children, with open fractures, with single incision access to both forearm bones, and following high energy injuries. Results of surgery for correction of synostosis are poor when surgery is performed less than one year or more than three years after injury, and even under ideal conditions, only one in five patients can be expected to regain as much as 50 degrees of forearm rotation.

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