Forearm 3

Proximal Third Frx above insertion of pronator teres.  proximal fragment of radius is

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supinated & flexed because of unopposed action of biceps brachii & supinator, and the distal fragment is pronated by the action of the pronator teres & pronator quadratus muscles. to obtain alignment of the fracture, the distal fragment should be supinated;

Middle Third Fractures below pronator teres

 proximal fragment is held in neutral rotation,

as action of supinator is countered by the pronator teres.  proximal fragment is drawn into flexion by action of biceps.  distal fragment is pronated & drawn toward ulna by pronator quadratus.  to achieve anatomic reduction, distal fragment is brought into neutral rotation

Distal Third Fractures below pronator teres

 distal fragment of the pulled radius is pronated & pulled inward by pronator quadratus.  overriding & shortening are caused by obliquity of frx & pull of muscles.

Pediatric Both Bone Forearm Fractures 

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frx may be greenstick or complete in both the radius and ulna. mechanism: - indirect injury during fall on an outstretched hand; - direct violence occassionally is cause of both bone forearm.

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in pts < 6 yrs of age: - upto 15 deg of angulation is acceptable, especially if frx is distal; - 5 deg of rotation may also be acceptable; - between ages of 6-10 yrs: - less than 10 deg of angulation should remodel especially if frx is close to distal epiphysis; - bayonet apposition may be acceptable, although end to end apposition is preferred; - acceptable angulation is less than 15 deg, however, even more angulation may be preferable to resorting to open reduction; - this is especially true if the reduction allows physiologic pronation and supination; - pts > 12 yrs of age: - no angulatory or rotational deformity is considered acceptable; - more aggressive treatment is required, including open reduction and compression plating may be required; - Displaced Distal Third Frx: - angulation up to 20-25 deg during first ten years is OK; - angulation > 10 deg is unlikely to correct after 10 yrs;