Characteristics

• Fall on out-stretched hand or direct trauma.

• May be in isolation or with associated ulna fracture, or with dislocation of the distal radio-ulnar joint – Galeazzi pattern – see below.

• Seen in both the adult and paediatric population.

Clinical features

• Pain, deformity, swelling, bruising and crepitus.

• Possible associated distal (Galeazzi) or proximal joint subluxation.

• Neurovascular injury possible.

• Compartment syndrome possible – look at passive stretching of dorsal and volar compartments.

Radiological features

• AP and lateral views – including the joints above and below should suffice.

• Displaced fractures have > 10° angulation (risking future pronation/supination), or > 50% displacement.

Management

• ABCs, analgesia, immobilisation with above-elbow backslab initially.

• Undisplaced fractures are treated non-operatively with closure of the backslab at approximately 7 days when the swelling has subsided, and changing to short arm cast at approximately 4 weeks until union.

• Displaced fractures require ORIF with a compression plate.

• In children MUA ± flexible ‘Nancy’ intramedullary nails should be performed.