A Breakdown of Forearm Fracture Types, Including Symptoms and Treatments

What starts as breaking a fall with an outstretched hand can easily end with breaking an arm. While some broken bone symptoms are painfully obvious, others aren’t. You may wonder if you’ve just dislocated or sprained something instead. That’s why any forearm fracture should be treated by a physician to avoid long-term complications.

The forearm is composed of two bones: the ulna and the radius. The ulna is on the pinky side of the arm, and the radius is on the thumb side. The distal ends are near the wrist, and the proximal ends are near the elbow. The ulna forms the bony point on the elbow. In adults, combined fractures (involving both bones) are the most common. In children, 75% occur near the wrist. Often, a patient with a forearm fracture also has a broken wrist or broken elbow.

Keep reading to learn more about different forearm fracture types, which symptoms should send you straight to the emergency room, and why you should see an upper extremity specialist for broken arm care.

Symptoms of a Broken Forearm

Forearm fractures are most common in kids ages 5 to 14 and women over 50. Lower bone density in middle-aged women puts them at a higher risk of a forearm fracture compared to men of the same age.

Primary broken arm/fracture in the forearm symptoms include:

• A snap or cracking sound
• Immediate sharp or stabbing pain that may increase with movement
• A visible deformity, such as a protruding bone (open fracture) or a bent arm
• Sensitivity to touch at any point in the arm, elbow, or wrist, especially in children

Secondary forearm bone fracture symptoms include:

• Swelling
• Bruising
• A crunching sound called crepitus, caused by broken fragments rubbing together
• Inability to put any weight on the hand
• Inability to rotate the arm from palm up to palm down

The location and description of the pain are critical in the case of a forearm fracture. This information helps doctors diagnose the type of break and whether you also may have a fractured wrist, broken elbow, damaged tendons, or nerve injury.

Emergency Situations

Young kids and older people are especially prone to complications if they don’t receive immediate attention for a forearm fracture. Err on the side of caution. Patients of any age should visit the emergency room with any of these symptoms:

• A bone breaking through the skin
• An open wound, which is at risk of infection
• Deformity of the elbow, arm, or wrist at an unnatural angle
• Inability to use the arm normally without pain
• Inability to move fingers
• Numbness around the injury
• Swelling that doesn’t respond to icing or anti-inflammatory medicine
• Discoloration of a fingernail when pressed is a sign of restricted blood flow

Diagnosing a Broken Lower Arm Bone

X-rays are the go-to method for confirming a fractured forearm and determining the specific type of break. Treatment varies greatly for different fractures.

The first step is telling the physician what happened, with as much detail as possible. If you fell, how far and how did you land? If you took a blow to the arm, where exactly? Also, your medical history contributes to the assessment.

Step two is a thorough physical exam. Physicians look at indicators such as wounds or deformities, range of motion, the location and severity of pain, bone dislocation, and blood flow. The exam may include gently rotating or pronating the arm and feeling or pressing along the arm. It will also assess the elbow, wrist, and hand for tendon damage and fractures.

Step three is taking X-rays to confirm a fracture and the extent of the damage, and look for fragments that may have broken off and moved (displacement).

Complex fractures may require a CT scan or an MRI for better visualization of the injury and surrounding structures.

Identifying Broken Forearms in Kids

Forearm fractures account for about 50% of all injuries during childhood, according to the Pediatric Orthopaedic Society of North America. Sports and playground falls are the major causes.

Soft bones and growth plates make for unique injuries. A pediatric upper extremity specialist uses a combination of physical exams and X-rays to look for the common kid fractures. A good description of what happened is valuable information because kids can’t communicate their symptoms as well as adults.

• Greenstick fracture: A partial forearm fracture that causes a bend on the unbroken side.
• Buckle or torus fracture: Only the top layer of the bone is broken, causing the bone to bend inward but not break all the way. The bones are not displaced.
• Growth plate fracture: Also called a physeal fracture, this break is usually a fractured radius near the wrist. Growth plates affect the development of the length of the arm. Immediate medical attention is critical.
• Displaced fracture: If both bones are broken and the pieces have shifted out of place, it’s an emergency condition.

Children may also experience some of the most common adult fractures, described in the next section.

Common Forearm Fracture Types

All age groups can experience the following types of fractures. They are categorized primarily by location and secondarily by factors such as displacement and the break’s shape or pattern.

Lower Arm Fractures Near the Wrist

A category called distal radius fractures affects the lower part of the arm, near the wrist.

• Colles fracture: A broken radius above the wrist that happens when the bone bends backward, usually from falling forward on an outstretched hand. It’s also called a “dinner fork” deformity.
• Smith fracture: Also called a reverse Colles fracture, it’s a similar injury with the wrist collapsing forward instead of backward.
• Distal ulna fracture: An isolated break in the smaller of the two bones near the wrist.
• Combined wrist-area breaks: A broken wrist in conjunction with an ulna or radius break.
• Galeazzi fracture: A specific combination—a radius fracture with a wrist dislocation.
• Chauffeur’s fracture: A break in the bony end of the radius, called the radial styloid process—the name refers to a time when chauffeurs cranked a car engine by hand.

Broken Bones in the Middle of the Forearm

Forearm fractures to the bone shaft, midway between the wrist and elbow, are often the result of a significant blow to the lower arm. Shaft fractures can involve one bone or both.

• Isolated ulna shaft fracture: A break in the ulna alone is called a “nightstick fracture,” named for blows from police batons, a common cause in the past from shielding one’s face from the stick.
• Isolated radius shaft fracture: Similar to a nightstick fracture, but contained to the radius bone and lacking a nickname.
• Both-bone fracture: A broken ulna and radius occurs more often in adults than in kids.

Fractures in the Forearm Near the Elbow

Proximal radius and ulna fractures are located near the elbow and may occur in combination with elbow-joint injuries. Elbow-area fractures are less common than wrist and shaft fractures, but tend to be more complex and require longer recovery time. They can result from a fall, a hard blow to the arm, or a strong contraction of the tricep muscle.

• Radial-head fracture: Damage to the end of the radius where it meets the elbow, often in conjunction with an elbow dislocation. Radial-head fractures account for 20% of elbow injuries.
• Proximal ulna fracture: Damage to the end of the ulna where it meets the elbow, called the olecranon.
• Monteggia fracture: An ulna fracture combined with a dislocated radial head at the elbow.

The Benefits of Expert Forearm Fracture Care

Prompt, specialized care from an upper extremity physician is critical when you break a bone (or both) in your forearm. With so many factors affecting forearm fractures, a precise diagnosis is the fastest route to reducing pain, ensuring the bone heals properly, and preventing complications, like chronic pain and permanent disability. It’s also the best bet for avoiding surgery, if at all possible.

Experienced specialists have a deep understanding of upper extremity anatomy and expertise in treating the entire spectrum of forearm injuries. They are the most qualified caregivers to determine whether you need a splint, sling, brace, or cast to make a full recovery as fast as possible.

IHTSC’s Best-in-Class Broken Forearm Bone Treatments

The orthopedic specialists at the Indiana Hand to Shoulder Center see broken forearms every day, from simple Colles fractures to complex Monteggia injuries. The most complicated cases come to us through referrals and our reputation for outstanding results.

At IHTSC, you are set up for an optimal recovery, regardless of the complexity of your lower arm bone break. Call us at 317-743-3985 to schedule a visit or book an appointment online.

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Reviewed by: Dr. Greg Merrell