The Forearm Is a Joint, Not Two Struts. That’s Why These Get Plated.
Break both bones of your forearm as an adult and you will almost certainly be offered surgery, even if the bones look reasonably lined up on the X-ray.
That surprises people who expect a cast, so here’s the reasoning.
Your radius and ulna aren’t two parallel sticks. The radius is bowed, and it rotates around the ulna every time you turn your palm up or down. That rotation is why you can
- turn a key,
- pour a drink,
- use a screwdriver or
- take money from a cashier’s hand (or someone’s hand haha)
Heal the radius even slightly straighter than it was, and that rotation is permanently reduced. Not the strength. Not the healing. The turn. And you don’t get it back with rehab, because the shape of the bone is now the limit.
The four fractures, and what each one means
- Both bones broken. The standard adult pattern from a fall or a road accident. Plates and screws on both, and early movement afterwards.
- Ulna alone, undisplaced. The nightstick fracture, from blocking a blow with the forearm. This is the one that genuinely can be treated without surgery if it hasn’t shifted.
- Radius fracture with a disrupted wrist joint. The Galeazzi. The break is in the radius but the two bones have also come apart down at the wrist.
- Ulna fracture with a dislocated radial head at the elbow. The Monteggia. The break is obvious. The dislocated elbow end is the bit that gets missed.
Those last two carry a rule worth remembering, because it’s how they stop being missed:
One forearm bone broken means both ends need checking. A single-bone forearm fracture usually can’t happen without something else giving way, at the elbow or at the wrist.
A missed dislocated radial head becomes a permanently unstable, painful, restricted elbow, and fixing it late is much harder than fixing it on day one. If you had a forearm fracture and your elbow has never felt right since, that’s worth raising.
What the operation does
A plate along each broken bone, screwed on either side of the break, restoring the length and the bow of the radius as precisely as possible.
The payoff is stability without a cast, and that’s the real prize: it means you can start moving your elbow and wrist within days rather than waiting six weeks for bone to knit.
Children are treated very differently though, it’s like it’s night and day difference – growing bone remodels, so a lot of paediatric forearm fractures do beautifully in a cast with an angle an adult surgeon would never accept.
The recovery, week by week
- Days 0 to 14: sling for comfort only, not immobilisation. Elevation to control swelling. Fingers, elbow and shoulder moving from the start. Early gentle rotation, palm up and palm down, on the surgeon’s word.
- Weeks 2 to 6: the rotation work is the priority and it needs doing daily. Keep the elbow tucked at your side so you’re turning your forearm rather than swinging your shoulder, which is the cheat everyone does without noticing.
- Weeks 6 to 12: bone union is usually visible on X-ray somewhere in here. Strengthening starts. Grip returns steadily.
- Months 3 to 6: heavier loading, return to manual work and most sport. Full power grip and confidence with impact usually sits at the far end of this.
- Beyond 6 months: what rotation you have is broadly what you keep.
The number I’d ask about at your reviews is rotation, in degrees, measured with your elbow at your side.
It’s the one that predicts how the arm actually functions, and it’s the one that quietly plateaus while everyone is pleased about the X-ray.
Complications worth knowing about
- Nerve trouble. The posterior interosseous nerve wraps around the upper radius, close to where a plate goes. Weakness lifting the fingers after surgery is usually a stretch injury that recovers over weeks to months, but it needs reporting rather than assuming.
- Swelling that keeps escalating. Severe, worsening pain in a tight forearm in the first day or two, far out of proportion, with pain on passively stretching the fingers, is compartment syndrome. That is an emergency, in hospital, within hours.
- Non-union. Bone that doesn’t knit, more likely in smokers and in high-energy open injuries.
- Bone bridging between the two bones. Uncommon, and it blocks rotation mechanically.
- Prominent hardware. The ulnar plate sits just under the skin along the edge of the forearm and some people can feel it constantly. Removal is possible but rarely done routinely, because taking a plate out leaves screw holes and a refracture risk for months afterwards. Discomfort has to be genuinely worth that trade.
The short version
Adult forearm fractures get plated because the forearm rotates, and rotation is unforgiving of a bone healing slightly the wrong shape.
If only one bone is broken, someone should have looked hard at your elbow and your wrist.
And in rehab, chase rotation. Everything else tends to come back on its own. That one doesn’t.
Written by Nigel Chua, hand occupational therapist in practice since 2005. Tens of thousands of hands, wrists and elbows assessed and treated. My credentials are here. This article explains; it doesn’t examine. Follow your own surgeon’s protocol where it differs. Severe escalating forearm pain after injury or surgery needs hospital assessment within hours.