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The Forearm Is a Joint, Not Two Struts. That’s Why These Get Plated.
Most adult forearm fractures are fixed with plates and screws, and the bone usually takes 3 to 4 months to heal solidly. You move the elbow and wrist within days, start rotation work in the first 2 weeks, strengthen from around 6 to 12 weeks, and most people are back to heavy work and sport at 4 to 6 months. The number that matters most is rotation: turning your palm up and down.
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.
What are the types of forearm fracture?
- 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, usually in a cast or brace, and the bone often takes 3 months or more to unite.
- 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.
Forearm pain without a fracture? Forearm pain by location sorts it by spot.
How is a forearm fracture diagnosed?
- X-rays of the WHOLE forearm, front and side, with the elbow and the wrist on the films. A view that stops short of either end can miss the half of the injury that matters most.
- The elbow check. On every view, a line drawn through the head of the radius should point straight at the bone it sits against at the elbow. If it doesn’t, that’s a Monteggia until proven otherwise.
- The wrist check. A widened gap between the two bones at the wrist, or the ulna sitting out of line, points to a Galeazzi.
- The nerve and circulation check. Can you lift your thumb and fingers, spread them, and feel normally across the hand?
- CT sometimes, for fractures that run into the elbow or wrist joints.
If only one bone is broken, someone should have looked hard at your elbow and your wrist.
Why do forearm fractures need surgery?
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. Night and day. Growing bone remodels, so a lot of pediatric forearm fractures do beautifully in a cast with an angle an adult surgeon would never accept. Some of those casts, and some adult splints, are built specifically to stop the forearm turning: see sugar-tong and Muenster splints.
Forearm fracture recovery week by week
Your surgeon may give you different dates. Use theirs.
- Days 0 to 14: sling for comfort only, not immobilization. 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 16: bone healing usually shows on X-ray somewhere in here, often toward the later end in adults. Strengthening starts once your surgeon is happy with the X-ray. Grip returns steadily.
- Months 4 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.
Where are you in the rotation window?
Name the window, find where you are in it, act while it’s still open.
- Weeks 0 to 12: OPEN. Rotation comes back fastest here. Daily work pays the most.
- Months 3 to 6: CLOSING. Still improving, but slower, and stiffness that’s there now is harder to shift. If you’re stuck, this is when to say so.
- Beyond 6 months: SHUT for exercise alone. What’s left is usually bone shape, the joints at either end, or bone bridging between the two bones. The question becomes a surgical one, not an effort one.
Exercises after a forearm fracture
Your surgeon’s protocol sets the start dates. These are the usual building blocks once you’re cleared.
- Fingers and fists (from day 1). Full fist, full open, 10 reps every 1 to 2 hours while awake. It pumps swelling out of the hand.
- Elbow and wrist bends (from the first days, if allowed). Bend and straighten each joint fully, 10 reps, 4 to 5 times a day.
- Rotation, elbow tucked. Elbow bent to 90 degrees and pinned to your side. Turn the palm up, hold 5 seconds, turn it down, hold 5 seconds. 10 reps each way, 4 to 5 times a day. If your elbow drifts away from your body, your shoulder is doing the turning.
- Weighted lever (usually from around week 6). Same position, holding a light hammer by the handle end. Let the weight of the head gently carry you a little further into the turn. Hold 15 to 20 seconds, 5 reps each way, 3 times a day. Choke up on the handle if it’s too much.
- Grip and strength (once the bone is healing on X-ray). Putty squeezes for 2 to 3 minutes, twice a day, then light dumbbell wrist curls and rotation, building slowly.
For reference: normal forearm rotation is roughly 80 to 90 degrees each way, and about 50 degrees each way covers most daily tasks. If palm-up is the stuck direction, can’t turn your palm up after a wrist fracture covers the same problem from the wrist end.
When can I drive, work and play sport after a forearm fracture?
- Desk work: often 1 to 2 weeks, one-handed at first.
- Driving: once you’re off strong pain meds, can grip and turn the wheel firmly, and could handle an emergency. After plating that’s commonly around 6 weeks. Ask your surgeon and your insurer. See driving after a hand or arm injury.
- Light manual work: around 6 to 12 weeks.
- Heavy manual work: around 4 to 6 months. See returning to work after a hand injury.
- Gym: light work from around 6 to 12 weeks. Push-ups, pull-ups and heavy pressing nearer 4 to 6 months.
- Contact sport and anything with a fall risk: usually 4 to 6 months, once the X-ray shows solid healing.
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.
What a hand therapist does differently here
Measures rotation in degrees at every visit, elbow pinned to your side, so a plateau shows up at week 6 instead of month 6. Catches the shoulder cheat. Adds a lever, a splint or a change of plan the week the number stalls.
Rotation is the number that quietly plateaus, so it’s the first one we measure.
Go to the emergency department if
- Severe, escalating forearm pain in the first days after the injury or surgery, out of proportion, worse when someone straightens your fingers, with a tight, hard forearm.
- Your fingers go numb, white, blue or cold.
- Bleeding soaks through the dressing, or bone is showing.
Call your surgeon today if
- Increasing redness, heat, discharge from the wound, or a fever.
- New weakness lifting the thumb or fingers after surgery.
- A new clunk, pain or deformity at the elbow or the wrist.
- The hand becomes shiny, swollen, color-changing and extremely sensitive. See CRPS.
Get it checked if
- Your rotation hasn’t improved between two visits in the first 3 months.
- Your elbow has never felt right since the fracture.
- The fracture site is still painful at 4 to 6 months.
- The plate catches or aches constantly where it sits under the skin.
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. 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.
Part of: Recovery after hand, wrist and elbow surgery: every week-by-week guide
Every article on this site is written using the Closing Window Method: name the window your condition runs on, find where you are in it, and act while it’s still open.