Review Question - QID 2859

The xray shows a comminuted, high energy both bone forearm fracture. Open reduction and internal fixation without bone grafting is the most appropriate treatment. Acute bone grafting is only indicated if a large bony void, such as segmental bone loss of the radius, is present to allow the displaced bone ends to heal together despite their diastasis.

In Moed et al's review, primary internal fixation in open forearm fractures led to nearly a 90% union rate (44/50) and good/excellent results in 85%. Autogenous cancellous grafting was anecdotally recommended if interfragmental compression could not be obtained.

In Wright et al's review, there was no significant difference between union rates in comminuted both bone forearm fractures whether or not autograft was used (97% v. 98%). The fractures in this series were all comminuted without open injuries.

Ring et al. reported on their series of comminuted forearm fractures, assessing risks of nonunion. They reported that the largest risk of nonunion was associated with polytrauma patients, followed by open injuries. They found no improvement in union with acute grafting any of their forearm injuries in this series.

Incorrect Answers:
1) An isolated closed forearm fracture such as this does not typically require external fixation unless soft tissue conditions prevent definitive fixation or splinting.
2) Flexible nailing of length-unstable forearm fractures is contraindicated.
3) Acute grafting is not associated with improved union rates in this fracture.
5) Closed reduction and functional bracing would lead to significant upper extremity disability due to malunion.