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ORIF of the Forearm Fractures

What are Forearm Fractures?

The forearm is made up of two bones, the radius and ulna. A break in both or either of the bones is known as forearm fracture. Forearm fractures can occur near the wrist, near the elbow, or in the middle of the forearm. A forearm fracture affects the ability to rotate your arm, as well as bend and straighten the wrist and elbow.

What does ORIF mean?

Open reduction and internal fixation (ORIF) is a surgical technique employed for the treatment of a forearm fracture to restore normal anatomy and improve range of motion and function.

Anatomy

The radius and ulna are long bones of the forearm that form the elbow at one end and the wrist at the other end. The radius is on the thumb side and the ulna lines up with the little finger, forming a bony protrusion at the elbow.

Causes of Forearm Fractures

Forearm fractures may occur in several ways, such as:

  • Fall on an outstretched arm
  • Direct blow to the forearm
  • A high-impact collision, such as motor vehicle accident
  • Contact sports

Signs and Symptoms of Forearm Fractures

Signs and symptoms of a forearm fracture may include:

  • Intense pain
  • Swelling and bruising
  • Deformity of the forearm
  • Numbness or weakness
  • Inability to rotate the arm
  • Tenderness to touch

Diagnosis

Your doctor will diagnose a forearm fracture by reviewing your signs and symptoms and performing a thorough physical examination. Your physician will:

  • Inspect the skin at the fracture site as bone fragments can cut through the skin and create lacerations.
  • Palpate your arm to determine areas of tenderness indicating soft tissue injuries or broken bones.
  • Check your pulse at the wrist to ensure good blood flow from the forearm to your hand.
  • Check your fingers and wrist for proper hand movements as injury to nerves may cause weakness and numbness of the hand and wrist.

Your doctor may also order an X-ray of the forearm to confirm the fracture. Sometimes, a computed tomography (CT) scan may be required to get a detailed view of the fractured fragments as well as injury to soft tissues.

Preparation for Surgery

Since ORIF is used to treat severe fractures, it often takes place as an emergency procedure. Prior to surgery, you may have:

  • Physical exam to inspect blood circulation and nerves affected by the fracture
  • X-ray, CT scan, or MRI scan to assess surrounding structures and broken bones
  • Blood tests
  • Depending on the type of fracture you have sustained, you may be given a tetanus shot if you are not up to date with your immunizations
  • A discussion with your doctor to determine the type of anesthesia that will be used, your current medications that may need to be stopped temporarily, and when to stop eating and drinking before the procedure. 

Treatment for Forearm Fractures

The management of forearm fracture comprises of non-surgical and surgical approaches. The choice of treatment depends on the type and severity of the fracture.

Non-surgical Treatment

Nonsurgical treatment basically involves placing the fractured forearm in a cast or brace for 4 to 6 weeks and providing a sling to keep your arm in the proper position. Your physician will closely monitor the healing process of the fracture with frequent X-rays and give instructions on restricted activities.

Surgical Treatment

Open reduction and internal fixation is the procedure employed most often to treat forearm fractures.

The surgery is performed under sterile conditions in the operating room under general anesthesia. 

  • After sterilizing the affected area, your surgeon will make an incision over the site of the fracture. 
  • Your surgeon will locate the fracture by carefully sliding in between the muscles of the forearm. 
  • The cuts from the injury and surfaces of the fractured bone are thoroughly cleaned out.
  • After carefully visualizing the fracture, the bone fragments are first repositioned (reduced) into their normal alignment. 
  • The fragments of bone are then held in place with wires, screws, pins, or metal plates attached to the outside of the bone. 
  • After securing the bone, the incisions are closed by suturing or staples along with sterile dressings to complete the operation. 

Postoperative Care

You may have some pain post procedure and pain medication will be prescribed to keep you comfortable. After surgery, your forearm will be placed in a short splint for support and protection. You will need to keep your arm immobile for several weeks with the aid of a sling to allow bone healing. Your doctor will provide instructions on dressings and incision care. 

Physical therapy is suggested to prevent forearm stiffness, strengthen muscles, and restore range of motion. You will also be advised on a healthy diet and supplements high in vitamin D and calcium to promote bone healing. 

Depending on your health condition and the extent of the injury, you may be able to go home the same day with scheduled follow-up appointments for monitoring progress and for stitches or staple removal if necessary.

Risks and Complications

As with any surgery, some of the potential risks and complications of open reduction and internal fixation of forearm fractures may include:

  • Bleeding
  • Swelling
  • Infection
  • Pain
  • Anesthetic complications
  • Damage to nerves and blood vessels
  • Hardware irritation
  • Fracture not healing
  • Broken hardware
  • Need for repeat surgery