FOREARM FRACTURE
This common fracture of the lower forearm is a frequent target of medical malpractice litigation. When there is little or no displacement, elastic bandaging was preferable to plaster casting, as measured by function a year later[1].
In cases of significant displacement, there may be poor alignment of the bone fragments at the initial setting of the fracture, but more often a poor cosmetic result occurs because of failure to undertake repeat radiographs at seven to 10 days[2].
PRACTICE POINT
Failure to re-xray after 7-10 days is substandard
Within this period, an originally good position often undergoes secondary displacement and malalignment.
In the elderly, resetting with external fixation[3] corrects the eventual deformity better than with repeat casting[4], but does not necessarily improve the eventual function[5]. After two to 3 weeks the fracture cannot be reset, and a later operation (osteotomy) is usually the best option.
PRACTICE POINT
In the elderly, substandard follow-up may not translate into a worse functional outcome
Surgical reconstruction of symptomatic malunion in the young and active is difficult, imperfect and frequently complicated. In the hands of experienced specialists it can be rewarding in functional improvement[6], [7].
Forearm fractures that involve the wrist joints vary widely in severity, depending on how many fragments there are and how displaced those fragments are [8]. Treatment recommendations are controversial, partly because the various fracture classifications do not adequately distinguish these aspects of severity.
The treated prognosis similarly depends on how many bone fragments there are and how well the wrist joints can be restored by surgery [9]. The most severe should arguably be treated from the start by hand specialists rather than general orthopedic surgeons.
Copyright © 2008 Electronic Handbook of Legal Medicine