ambossIconambossIcon

Forearm fractures

Last updated: June 28, 2023

CME information and disclosurestoggle arrow icon

To see contributor disclosures related to this article, hover over this reference: [1]

Physicians may earn CME/MOC credit by reading information in this article to address a clinical question, and then completing a brief evaluation, in which they will identify their question and report the impact of any information learned on their clinical practice.

AMBOSS designates this Internet point-of-care activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only credit commensurate with the extent of their participation in the activity.

For answers to questions about AMBOSS CME, including how to redeem CME/MOC credit, see "Tips and links" at the bottom of this article.

Summarytoggle arrow icon

Fractures of the radius and/or ulna occur frequently. Important forearm fracture patterns include complete forearm fractures, Galeazzi fractures, and Monteggia fractures. Fractures of the forearm bones at the elbow level include radial head fractures and olecranon fractures, while those at the wrist level include distal radius fractures. The mechanism of injury can be low-energy, such as a fall on an outstretched hand (FOOSH), or high-energy, such as a motor vehicle collision (MVC). Clinical presentation is typically characterized by pain near the fracture site, gross deformity, and swelling. X-ray is the main diagnostic modality. Evaluation includes imaging of the forearm; wrist and elbow imaging are added for moderate to severe injuries. Management varies depending on the age group and fracture characteristics, and includes a thorough neurovascular assessment, acute immobilization, pain management, and referral to orthopedics for definitive open reduction and internal fixation (ORIF) or closed reduction and casting.

For more details on fractures involving the distal radius, see “Distal radius fractures.”

Overviewtoggle arrow icon

Relevant anatomy

Important musculoskeletal structures

Important neurovascular structures

Overview of forearm fractures

Overview of radius and ulna fractures
Affected structures Mechanism of injury Management

Fractures with elbow involvement

Monteggia fracture
  • Fall onto an outstretched and pronated forearm and extended wrist
  • Direct high-energy trauma to the forearm
Isolated radial head fracture
Olecranon fracture
Fractures of the mid-forearm

Complete forearm fracture

(Combined radial and ulnar shaft fracture)

  • FOOSH
  • Direct high-energy trauma to the forearm
Isolated radial shaft fracture [2]

isolated ulnar shaft fracture

(Parry fracture; nightstick fracture) [2][3]

  • Direct trauma (high or low-energy)
  • Typically a defensive injury
Fractures with wrist involvement Galeazzi fracture
  • Fall onto an outstretched and pronated forearm and extended wrist
Colles fracture
  • Radial and dorsal displacement of the distal fragment of the radius
  • FOOSH on extended wrist
Smith fracture
  • Radial and volar displacement of the distal fragment of the radius
Barton fracture
  • Radial avulsion and dorsal displacement of the radiocarpal segment of the radius

Reverse Barton fracture

  • Avulsion and volar displacement of the radiocarpal segment

Hutchinson fracture

Die-punch fracture
  • Axial loading force applied against the distal radius
Ulnar styloid fracture [4]
Fractures with elbow and wrist involvement Essex-Lopresti injury [3]
  • Refer to orthopedics within 7–10 days for surgical management.

Initial managementtoggle arrow icon

The following are indicated irrespective of the fracture type and bones involved: [2][3]

Complete forearm fracturestoggle arrow icon

Thoroughly evaluate patients with complete forearm fractures for signs of compartment syndrome. [5]

Monteggia fracturetoggle arrow icon

Adults with displaced Monteggia fractures require urgent ORIF. [3]

In patients with ulnar fractures, evaluate the radiocapitellar line to check for disruption of the proximal radioulnar joint. [2]

Galeazzi fracturetoggle arrow icon

Almost all Galeazzi fractures require open reduction and repair of the distal radioulnar joint. [3]

Radial head fracturetoggle arrow icon

Treat a positive elbow fat pad sign with corresponding bony tenderness as an occult fracture. [3]

Olecranon fracturetoggle arrow icon

Ensure rapid orthopedic follow-up for all patients with olecranon fractures, as most are considered intraarticular and require near-perfect reduction to preserve full ROM. [2][5]

Referencestoggle arrow icon

  1. Sherman SC. Simon's Emergency Orthopedics, 8th edition. McGraw Hill Professional ; 2018
  2. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine 10th edition- Concepts and Clinical Practice E-Book. Elsevier Health Sciences ; 2022
  3. Roettges P, Turker T. Ulnar Nerve Injury as a Result of Galeazzi Fracture: A Case Report and Literature Review. Hand. 2017; 12 (5): p.NP162-NP165.doi: 10.1177/1558944717715137 . | Open in Read by QxMD
  4. Matthias R, Wright T. Interosseous Membrane of the Forearm. J Wrist Surg. 2016; 05 (03): p.188-193.doi: 10.1055/s-0036-1584326 . | Open in Read by QxMD
  5. Eiff MP, Hatch RL. Fracture Management for Primary Care and Emergency Medicine. Elsevier ; 2019
  6. Walls R, Hockberger R, Gausche-Hill M. Rosen's Emergency Medicine. Elsevier Health Sciences ; 2018
  7. Pappas N, Bernstein J. Fractures in Brief: Radial Head Fractures. Clin Orthop Relat Res. 2010; 468 (3): p.914-916.doi: 10.1007/s11999-009-1183-1 . | Open in Read by QxMD
  8. Swensen SJ, Tyagi V, Uquillas C, Shakked RJ, Yoon RS, Liporace FA. Maximizing outcomes in the treatment of radial head fractures. J Orthop Traumatol. 2019; 20 (15).doi: 10.1186/s10195-019-0523-5 . | Open in Read by QxMD
  9. Wolfson AB. Harwood-Nuss' Clinical Practice of Emergency Medicine. LWW ; 2014
  10. de Muinck Keizer RJO, Walenkamp MMJ, Goslings JC, Schep NWL. Mason Type I Fractures of the Radial Head. Orthopedics. 2015; 38 (12).doi: 10.3928/01477447-20151123-06 . | Open in Read by QxMD
  11. Foocharoen T, Foocharoen C, Laopaiboon M, Tiamklang T. Aspiration of the elbow joint for treating radial head fractures. Cochrane Database Syst Rev. 2014; 22 (11).doi: 10.1002/14651858.cd009949.pub2 . | Open in Read by QxMD
  12. Logan AJ, Lindau TR. The management of distal ulnar fractures in adults: a review of the literature and recommendations for treatment. Strategies in Trauma and Limb Reconstruction. 2008; 3 (2): p.49-56.doi: 10.1007/s11751-008-0040-1 . | Open in Read by QxMD
  13. $Contributor Disclosures - Forearm fractures. None of the individuals in control of the content for this article reported relevant financial relationships with ineligible companies. For details, please review our full conflict of interest (COI) policy:.

Icon of a lock3 free articles remaining

You have 3 free member-only articles left this month. Sign up and get unlimited access.
 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer