In uncomplicated cases, union takes place in from three to four weeks.
Fig. 42.—Gooch Splints for Fracture of both Bones of Forearm. (These are applied with the wooden side towards the skin.)
Treatment.—To ensure accurate reduction and coaptation, a general anæsthetic is usually necessary. In the greenstick variety the bones must be straightened, the fracture being rendered complete, if necessary, for this purpose.
To retain the bones in position, anterior and posterior splints are then applied. These are made to overlap the forearm by about half an inch on each side, to avoid compressing the forearm from side to side, and so making the fractured ends encroach upon the interosseous space. The dorsal splint is usually made to extend from the olecranon to the knuckles, and the palmar one from the bend of the elbow to the flexure in the middle of the palm, a piece being cut out to avoid pressure on the ball of the thumb ([Fig. 42]). The splints are applied with the elbow flexed to a right angle, and, except when the radius is broken above the level of the insertion of the pronator teres, with the forearm midway between pronation and supination. The limb is placed in a sling, so adjusted that it supports equally the hand and elbow in order to avoid angular deformity. The use of special interosseous pads is to be avoided.
When the fracture of the radius is above the insertion of the pronator teres, the forearm should be placed in the position of complete supination, with the elbow flexed to an acute angle, and retained in this position by a moulded posterior splint, and the arm fixed to the side by a body bandage. Great care is necessary in the adjustment of the apparatus to prevent pronation.
Massage and movement should be carried out from the first. It is usually necessary to continue wearing the splints for about three weeks.
In cases of mal-union, especially when the bones are ankylosed to one another across the interosseous space, operation may be necessary, but it is neither easy in its performance nor always satisfactory in its results. The seat of fracture should be exposed by one or more incisions so placed as to enable the muscles to be separated and to give access to the callus. When the limb is straight, it is only necessary to gouge away the exuberant callus that interferes with rotatory movements; but when there is an angular deformity the bones must, in addition, be divided and re-set, and, if necessary, mechanically fixed in good position. In comparatively recent cases it is sometimes possible, without operation, to re-fracture the bones and to set them anew.
Un-united fracture of both bones of the forearm is not uncommon and is treated on the usual lines; the gap between the fragments of the radius is bridged by a portion of the fibula, that should be long enough to overlap by at least an inch at either end; it is rarely necessary to bridge the gap in the ulna, unless it alone is the seat of non-union.