Question 1

Why do adult forearm fractures almost always need surgery when children's forearm fractures usually heal fine in a cast?

Accepted Answer

This is one of the key differences between pediatric and adult fractures. Children's bones have growth plates and tremendous remodeling potential—even if a child's forearm heals slightly crooked in a cast, the bone will straighten itself over 1-2 years as the child grows. Adults have no remodeling capacity. If an adult forearm fracture heals even 5-10 degrees rotated or with a few millimeters of shortening, this causes permanent loss of forearm rotation (supination/pronation - the palm-up, palm-down movement). The forearm is unique in requiring precise restoration of the relationship between radius and ulna to allow smooth rotation. Studies comparing casting versus surgery in adults show that casting results in malunion (crooked healing) or nonunion (failure to heal) in 50-60% of cases, while surgery has 90-95% success rate. Malunion causes 30-50% permanent loss of forearm rotation which significantly impacts daily activities like turning doorknobs, using utensils, typing. This is why nearly all orthopedic surgeons recommend surgery for displaced adult forearm fractures—the risk of poor outcome with casting is simply too high.

Question 2

Will I regain full forearm rotation and hand function after surgery?

Accepted Answer

Most patients (80-85%) regain good forearm rotation and hand function with proper surgery and rehabilitation, but complete return to 100% of pre-injury rotation is uncommon. Expect to recover about 80-90% of normal forearm rotation (supination/pronation range). This is usually sufficient for most daily activities and work. Factors affecting recovery: (1) Severity of initial injury - simple transverse fractures heal better than comminuted (shattered) fractures; (2) Surgical technique - precise restoration of radial bow and rotation critical; (3) Development of synostosis - if radius and ulna fuse together (2-5% risk), this eliminates forearm rotation requiring surgery to separate bones; (4) Physiotherapy compliance - starting gentle rotation exercises at 2-3 weeks and progressing methodically is absolutely critical; patients who don't do physiotherapy have permanent stiffness. Plan on 3-6 months of dedicated physiotherapy to maximize recovery. Most patients return to previous work including manual labor, though some activities requiring extreme supination/pronation (like using a screwdriver) may be more difficult. If you develop significant stiffness despite proper treatment, some patients benefit from hardware removal after 12-18 months which can improve range of motion.

Medical Disclaimer

Broken Forearm in Adults (Both-Bone Forearm Fracture)

📖What is Broken Forearm in Adults (Both-Bone Forearm Fracture)?

🔬What Causes It?

⚠️Risk Factors

You may be at higher risk if:

🛡️Prevention