Indications

• Displaced fractures of the ulnar shaft in adolescents/adults.

• Fractures of the ulnar shaft with fracture and dislocation of the proximal radius/radial head (Monteggia fractures).

• Fractures of both forearm bones.

Clinical assessment

• Define mechanism of injury: high or low-energy trauma, isolated or complex trauma, direct trauma, nightstick type of injury, axial compression, Monteggia fractures, or expression of combined forces.

• Exclude open wounds: assess extremity without the presence of any splint or dressing. If any, record location and size of the wound (clinical photograph should be taken), cover with moist dressing, immediately initiate broad-spectrum intravenous antibiotics and tetanus prophylaxis, follow local clinical pathway of open fractures.

• Initial and follow-up observations of the neurovascular status and signs of compartment syndrome.

• Adequate examination of the adjacent joints (elbow and wrist) for associated trauma or previous pathologies.

• Exclude occult injuries of the rest of the extremity, especially of the carpus and/or hand. Note history of previous trauma or surgery of the extremity.