Overview
The forearm is two bones, the radius and the ulna, joined by the interosseous membrane and linked at joints at the elbow and wrist. Together they work as a single rotating unit: turning the palm up and down is the radius swinging around the ulna. If the bones heal with even a modest bend or shortening, the arc of rotation is permanently reduced, so adult forearm fractures are treated like joint injuries and the goal is anatomic alignment rather than just healing.
Treatment is decided by which bone is broken, whether the fracture is displaced, and whether the joint at either end has come apart. An isolated, minimally displaced ulna fracture can be treated in a brace. A displaced fracture of both bones in an adult, or a fracture of one bone with a dislocation of the other at the wrist (Galeazzi) or the elbow (Monteggia), is unstable and is usually treated with plate fixation. In children, whose bones remodel, casting is far more often appropriate.
Common Symptoms
- Immediate severe pain and swelling of the forearm after a fall or a blow
- Visible deformity: a bend, a shortened appearance, or an arm that looks crooked
- Inability to turn the palm up or down, or to lift the arm without supporting it
- Numbness or tingling in the hand, which needs prompt assessment
The joints at each end must be checked. Pain concentrated at the wrist is more often a distal radius fracture; clicking on the little-finger side of the wrist after the forearm has healed can be a TFCC tear from the same injury; and a fracture near the elbow may be an olecranon fracture.
Causes & Risk Factors
A direct blow to the forearm, typically the arm raised to protect the face, breaks the ulna alone (the nightstick fracture). A fall onto an outstretched hand with the arm twisting, or a high-energy impact in a motorcycle crash, football tackle, mountain-bike or ski fall, breaks both bones. In children they are among the most common fractures. In adults under 40 the injury is almost always high-energy; over 65, a fall from standing height can be enough when bone density is reduced, and a fragility fracture is a reason to check bone density.
How It Is Diagnosed
Dr. O'Donnell checks the skin for any wound that would make the fracture open, feels the forearm compartments for the tightness that signals dangerous pressure, tests the median, ulnar and radial nerves, and confirms the pulse. He then examines the wrist and elbow specifically, because a dislocation of the ulnar head at the wrist or the radial head at the elbow changes the operation.
X-rays of the forearm that include both the wrist and elbow joints are the essential study and usually the only one: they show the fracture pattern, displacement, angulation and shortening, and whether the joints are aligned. CT is added when a fracture extends into a joint; MRI is rarely needed. Out-of-area patients can upload their films through mymedicalimages.com so the plan is ready before the first visit.
Imaging Findings in People Without Symptoms
A forearm fracture is a fresh injury, and the X-ray shows it plainly. What a later scan can show is the record of an old one: a healed fracture, a slight bend left from healing, or a plate and screws. Those show a bone was broken once, not that it hurts now.
For a new fracture, Dr. O'Donnell decides between a brace and a plate from the X-ray: how far the bone ends have shifted, whether the forearm is bent or shortened, and whether a joint has come apart, weighed against age and activity. On a later scan, an old plate or a healed bend explains current symptoms only when the examination finds pain or lost rotation at that spot.
An old or slightly bent forearm fracture on an X-ray is not by itself a reason for surgery. A displaced fracture of both bones is usually plated; an ulna fracture that has barely moved heals in a brace.
Treatment Options
Non-operative care
Casting or a functional brace is right for a minority of adult forearm fractures: isolated ulna shaft fractures with less than half the bone width of displacement and minimal angulation, with intact wrist and elbow joints, and stable fractures in patients too frail for surgery. These are X-rayed every one to two weeks for the first month to confirm alignment is holding, and the brace stays on for about six to ten weeks. Most children's fractures are treated this way, because young bone corrects residual angulation as it grows.
Plate fixation (ORIF)
For displaced fractures of both bones, any Galeazzi or Monteggia pattern, open fractures, and displaced radius fractures, Dr. O'Donnell performs open reduction and internal fixation, described on the wrist and forearm fracture fixation page. Each bone is realigned under direct vision and held with a compression plate and screws, which restores the length and bow of the radius that rotation depends on and is rigid enough to allow early motion. Surgery is generally scheduled within the first week, as an outpatient with a nerve block and general anesthesia, and the plates are usually left in permanently.
Recovery & What to Expect
Forearm bone is slow to unite. Motion starts early because the plates hold the bones; loading waits for the X-ray. The phases below are from Dr. O'Donnell's both-bone forearm protocol.
| Phase | Timing | What happens |
|---|---|---|
| Early motion | Weeks 0–2 | Splint between exercises; full active finger, elbow and shoulder motion from day one; gentle wrist and forearm rotation as directed. No gripping loads or weight bearing. |
| Motion | Weeks 2–6 | Wrist, forearm and elbow motion progressed to full, gentle stretching toward complete rotation, scar mobilization. No resisted strengthening or lifting. |
| Strengthening | Weeks 6–12 | Begins only after Dr. O'Donnell confirms adequate healing on X-ray: progressive grip, wrist and forearm-rotation strengthening, work conditioning. |
| Return to activity | Months 3–6 | Sport- or job-specific loading. Heavy loading and contact wait for confirmed union, which can take 3–4 months, and surgeon clearance. |
Desk work is possible within a week or two with the arm in a splint; driving waits until the splint is off and rotation can control the wheel, usually around four to six weeks; lifting through the arm is not permitted until union is confirmed, often 10 to 12 weeks or more; and contact sports and heavy lifting return in the fourth to sixth month. The protocol is available as a PDF: both-bone forearm fracture ORIF.
Frequently Asked Questions
Can a forearm fracture heal without surgery?
In children, usually yes, in a cast. In adults, only when a single bone is broken, the displacement is small and the wrist and elbow joints are intact. A displaced fracture of both bones heals crooked in a cast, and even a slight bend permanently limits turning the palm up and down, so plate fixation is the standard treatment.
My X-ray shows a forearm fracture. Does that mean I need surgery?
It depends on the pattern. A displaced fracture of both forearm bones in an adult, or a fracture with a dislocated wrist or elbow joint, is usually plated, because even a small bend limits forearm rotation. A single ulna fracture that has barely moved heals in a brace. In older adults, a modest leftover deformity rarely affects function, so alignment is weighed against age and demands.
How long does a forearm fracture take to heal?
Longer than most fractures. Early healing is usually visible on X-ray by six weeks, but solid union often takes 10 to 12 weeks and sometimes longer. Motion begins within days of plate fixation; strengthening, lifting and contact wait for the X-ray to confirm the bone has bridged.
When can I drive after a forearm fracture?
Once the splint is off, you can rotate the forearm enough to steer, and you are no longer taking narcotic pain medication. For most patients after plate fixation that is around four to six weeks. Driving one-handed in a splint is not recommended.
Do the plates need to come out?
Usually not. Forearm plates are left in permanently unless they cause irritation, and removal carries a real risk of re-fracture through the old screw holes in the first months after the plate is out. If removal is ever considered, it is delayed until at least a year after the injury.
What is a Galeazzi or Monteggia fracture?
Both are fracture-dislocations. In a Galeazzi injury the radius is broken and the ulna has dislocated at the wrist; in a Monteggia injury the ulna is broken and the radial head has dislocated at the elbow. Both are unstable and are generally treated surgically in adults.
This page is for general education and is not a substitute for a medical evaluation. Treatment recommendations depend on your individual diagnosis and goals. Kevin O'Donnell, MD sees patients from Coral Gables, Miami, Brickell, Pinecrest and Coconut Grove at 475 Biltmore Way, and out-of-town patients by telemedicine.