The Centers for Advanced Orthopaedics
Maryland Orthopedic Specialists
A Division of The Centers for Advanced Orthopaedics
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Hand & Wrist

Forearm Fractures

Forearm fractures (involving the radius, the ulna, or both bones) are common injuries from falls, motor vehicle accidents, and sports impacts. The forearm is not simply a structural arm segment; it is a complex rotational unit, and fractures that disrupt its anatomy can severely limit the ability to pronate and supinate the forearm. Accurate diagnosis and appropriate management, which in displaced adult fractures almost always means surgical fixation, are essential to restoring full forearm function.

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What is forearm fractures?

A forearm fracture is a break in one or both of the forearm bones, the radius and the ulna, most often caused by a fall or direct blow. Symptoms include pain, swelling, deformity, and difficulty rotating the wrist. Treatment ranges from casting to surgery depending on the break.

Symptoms — do you recognize these?

  • Pain, swelling, and deformity of the forearm following trauma
  • Limited or painful forearm rotation (pronation/supination)
  • Tenderness along the radius and/or ulna
  • Signs of neurovascular compromise (anterior interosseous nerve or posterior interosseous nerve injury may accompany Monteggia fractures)

Call us at (301) 515-0900. Same-day appointments available at our Bethesda and Germantown locations.

How we diagnose it

  • X-rays of the forearm (PA and lateral): Must include the entire forearm, elbow, and wrist on the same film. Fracture-dislocations are commonly missed when imaging stops at the fracture site.
  • CT scan: Reserved for complex intra-articular patterns or when plain films are equivocal.
  • Neurovascular exam: Assessment of radial, median, and ulnar nerve function; radial pulse; compartment pressures if swelling is significant.

Treatment options

Non-Operative

A functional brace is an option for isolated, non-displaced ulnar shaft fractures, allowing the elbow and wrist to move while the bone heals over six to eight weeks.

Surgical Treatment (ORIF)

Displaced fractures, injuries to both bones, and fracture-dislocations such as Monteggia and Galeazzi patterns require plate fixation to restore alignment. Rigid fixation holds the bones in the correct position and allows early movement of the wrist and forearm during recovery.

Recovery & rehabilitation

  • Non-operative: 6–10 weeks of bracing; gradual return to activity; formal therapy if stiffness develops.
  • ORIF: Removable splint at 1–2 weeks; progressive forearm rotation, grip, and wrist motion exercises; return to unrestricted activity (including sports) at 3–4 months once radiographic union is confirmed.

Restoration of pronation and supination is the primary rehabilitation goal.

Frequently Asked Questions

Why do adult forearm fractures almost always need surgery?
The interosseous membrane and strong forearm muscles cause displaced fragments to shorten and rotate. Plaster casts cannot maintain alignment against these forces, and malunion produces permanent limitation of forearm rotation. Children, whose bones have greater remodeling potential, can often be managed in casts; adults cannot.
What if the elbow doesn't hurt? Do I still need elbow X-rays?
Yes. The elbow X-ray is mandatory after any forearm fracture to identify an associated radial head dislocation (Monteggia). The elbow may not be painful despite joint disruption.
Are the plates removed after healing?
In adults, plates are generally left permanently unless they cause symptoms. Plate removal is an elective procedure typically not performed before 18–24 months post-fixation.
How long does recovery take after surgical fixation of a forearm fracture?
Bone healing typically takes eight to twelve weeks after plate-and-screw fixation of a forearm fracture, though early controlled motion of the wrist and elbow usually begins within the first one to two weeks. Regaining full forearm rotation (pronation and supination) can take three to six months and depends greatly on the quality of fracture reduction and commitment to rehabilitation. Your MOS surgeon will coordinate care with a hand therapist to maximize your functional recovery.
Will I lose forearm rotation permanently after a fracture?
Most patients regain excellent forearm rotation after well-aligned surgical fixation, but some permanent loss is possible, particularly after comminuted (multi-fragment) fractures or those involving the radial head. Malunion (healing in a twisted or angulated position) is the most common reason for lasting rotational loss, which is why precise fracture reduction during surgery is so important. Physical therapy including progressive forearm rotation exercises is an essential part of recovery to maximize the rotation you regain.

Meet the specialists

Peter G. Fitzgibbons, MD

Peter G. Fitzgibbons, MD

Hand Surgery · Orthopedic Surgery

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Related conditions

Hand & Wrist FracturesElbow FracturesJoint Dislocations in the Hand
Medically reviewed by Peter G. Fitzgibbons, MD
Last reviewed May 1, 2026

References

  1. Noonan KJ, Price CT. Forearm and distal radius fractures in children. Journal of the American Academy of Orthopaedic Surgeons. 1998;6(3):146–156. doi:10.5435/00124635-199805000-00002
  2. Schemitsch EH, Richards RR. The effect of malunion on functional outcome after plate fixation of fractures of both bones of the forearm in adults. Journal of Bone and Joint Surgery (American). 1992;74(7):1068–1078. doi:10.2106/00004623-199274070-00013
  3. Goldfarb CA, Ricci WM, Tull F, Ray D, Borrelli J Jr. Functional outcome after fracture of both bones of the forearm. Journal of Bone and Joint Surgery (British). 2005;87(3):374–379. doi:10.1302/0301-620X.87B3.15625
  4. Jupiter JB, Kellam JF. Diaphyseal fractures of the forearm. In: Browner BD, et al. Skeletal Trauma, 4th ed. Philadelphia: Saunders; 2009. AAOS OrthoInfo Reference: https://orthoinfo.aaos.org
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