Forearm Injuries

Coronavirus / COVID-19 update

During the COVID-19 risk period, wherever possible we’ll be reducing face-to-face appointments and helping you manage your injury remotely. This means that, in accordance with the British Orthopaedic Association guidelines, your individual treatment and follow up plan may be different to what happens under normal conditions. An orthopaedic consultant or a member of the orthopaedic team will always review your notes and x-ray and decide if a face-to-face follow up is necessary.

If we haven’t asked to see you for a follow up, we may offer you an open appointment, where you can make an appointment to see someone at any time in the six months after your injury. If you’d like to book an appointment, please call 01736 758892.

Medication

The Emergency Department (ED) or a Minor Injury Unit (MIU) may have prescribed you with some pain relief. Take these as instructed to help manage the pain. If you do not feel that this medication is helping, talk to us during your appointment in Fracture Clinic, or your GP, about an alternative option.

Cold packs

Ice is a great natural anaesthetic that helps relieve pain and controls swelling. Apply ice packs or a bag of frozen peas wrapped in a wet thin towel to your arm for up to 15 minutes every few hours.

• Do not place ice in direct contact with the skin.
• Do not leave the ice pack on for more than 20 minutes at a time in one hour.

Rest and elevation

It’s important to rest your arm as much as possible in the first 24 to 72 hours.

You will have been fitted with a plaster and given a sling. Keep your arm elevated in the sling. This will help to reduce your swelling and pain.

During the evening and at night, you may find it more comfortable to elevate your arm on a couple of pillows.

Smoking

Medical evidence suggests that smoking prolongs fracture healing time. In extreme cases it can stop healing altogether. Stopping smoking during the healing phase of a fracture will help ensure optimal recovery from this injury.

For advice on stopping smoking and local support available, please discuss this with your GP or go to the NHS Smoke Free website.

Helping your recovery

Being healthy can help you recover from your injury faster. Eating well, staying hydrated and keeping as active as possible will all help. We’ve put together a set of videos on all the things you can do to help you recover as quickly as possible.

The information below will help you understand your injury, guide you through your rehabilitation and explain what you can do to maximise your recovery.

Your diagnosis should have been made by an orthopaedic consultant or one of the team working under the supervision of the consultant team. The information in this care plan is to help you understand your diagnosis and is not exhaustive. Your consultant may give you a different, personalised care plan based on your injury and whether you need imaging (x-ray, CT scan, MRI or an ultrasound) or an operation.

What is your injury?

You have broken a bone or multiple bones in your lower arm. These injuries commonly happen during a collision or high energy fall.

Healing

It normally takes 12 to 16 weeks to heal.

Forearm fractures have a higher risk of not healing properly, especially if you smoke.

Complications of forearm fractures

Compartment syndrome is a rare but potentially serious complication of forearm fractures. It’s caused by bleeding or swelling within an enclosed bundle of muscles – known as a muscle compartment. It causes intense pain, especially when the muscle is stretched. Read more about compartment syndrome on the NHS website.

The bones in the forearm may not heal properly. They may:

• take longer than normal to heal – known as delayed union,
• heal in an abnormal position – known as malunion. Malunion can cause functional impairment,
• not unite back together – known as non-union.

Smoking can lead to longer healing times and smokers are at twice the risk of experiencing non-union, especially if they have an open fracture.

Forearm fractures can also cause damage to nerves or blood vessels.

Follow up

You’ll see a member of the orthopaedic team in the first 2 weeks after your injury. You might need a further x-ray or we may give you another cast. The doctor will explain the next stage of your recovery and tell you if you need an operation.

You can also book an open appointment at any time in the 6 months after your injury. Please call 01736 758892 to make an appointment.

Please call the Fracture Clinic on 01872 253091 if:

• you’re unable to follow this rehabilitation plan
• you have any questions
• you’re struggling with your sling
• you notice pain in an area other than your forearm.

In some cases you may need an operation to realign your bones. This may involve putting plates, screws or rods inside your arm. Sometimes we may need to use a temporary external frame.

Your surgeon will discuss the benefits and risks of surgery so you can make an informed decision about whether to have the operation.

What are the risks with surgery?

If you’re overweight, smoke or not active, you’re at greater risk of developing complications after surgery. It may take longer to recover.

Possible complications that you should be aware of include:

• scarring on the arm
• damage to tendons, nerves or blood vessels
• infections, which we can treat with antibiotics
• further surgery if wounds become more deeply infected
• nerve pain (in rare cases) which may need further treatment
• further surgery if the fracture is not stable or does not heal properly.

Most complications are minor and can be treated easily and successfully.

How long will I spend in hospital after my operation?

Forearm surgery patients generally go home the same day. You may need to spend one night in hospital.

After surgery you’ll need to strictly rest and elevate your arm. You can expect to be up and active within 48 hours. Your surgeon will tell you more about this.

Managing your injury after surgery

For the first 6 weeks you may need a sling to protect your arm, help support you and manage swelling. Stop using the sling as soon as it feels comfortable to do so. This will help you avoid a stiff elbow.

You can find out more about having an operation on our surgery for fractures and soft tissue injuries page.

Early movement

Start the exercises below as soon as possible. You can move your shoulder and neck as normal to stop them becoming stiff.

It’s important that you can always move your fingers and have full feeling in your hand. If you lose movement or feeling, go to the emergency department immediately.

Exercises to do immediately

Do these exercises every day. They’ll help you regain any loss of movement

Moving your shoulder

You can move your shoulder as normal. Try to move it daily to help your shoulder stay mobile.

Moving your neck

It’s also important to stretch your neck muscles. Remove your sling and:

• look up
• look down
• look left
• look right
• look side to side.

Repeat this a few times every day.

Exercises to do when your cast has been removed

Do these exercises 3 to 4 times a day, 10 times each as shown in the pictures below.

More information

You can find out more about your injury, and see demonstrations of the exercises in this video from Brighton & Sussex University Hospitals.

Using your sling

Wear your sling during the day for up to 6 weeks. You can take it off to wash, dress and exercise. You don’t need to wear it at night.

Once your plaster has been removed, stop using the sling as soon as it feels comfortable to do so. This will help you to gently mobilise the elbow so it doesn’t become stiff.

You can see more about how to fit your sling, and washing, dressing, sleeping and sitting with your sling in these videos.

If you’re struggling with your sling, please call the Fracture Clinic on 01872 253091 and we’ll be happy to give you advice.

Your plaster cast

We may put your arm in a plaster cast to encourage healing and good alignment.

Keep your cast clean and dry. You can find out more about caring for your plaster cast here.

If you have significant problems with your cast, please call the plaster room on 01872 253234 or attend ED out of office hours.

How to manage your forearm after the cast has been removed

We recommend that you:

• soak your arm in warm water if it’s swollen or it aches
• massage it regularly with oils or hand cream directed towards your elbow
• elevate your hand and arm on pillows if they feel swollen and keep your fingers moving
• keep your shoulder and wrist moving to reduce stiffness
• use your wrist, hand and arm as normally as possible when we tell you to do so

Caring for your wound after an operation

If you’ve had an operation on your forearm, you’ll need to keep your stitches dry and clean. You should also look out for any redness or signs of swelling, bleeding or pus as these can be signs of an infection.

You can find information about how to care for your stitches, if/when they need to be removed and signs of an infection on our surgery for fractures and soft tissue injuries page.

Blood clots and Deep Vein Thrombosis (DVT)

Because your limb is immobilised and you’ll be moving less than normal, you’re at higher risk of developing a blood clot or Deep Vein Thrombosis (DVT). This can be life threatening if left untreated.

Symptoms of DVT in the leg are:

• throbbing or cramping pain in 1 leg (rarely both legs), usually in the calf or thigh
• swelling in 1 leg (rarely both legs)
• warm skin around the painful area
• red or darkened skin around the painful area
• swollen veins that are hard or sore when you touch them.

These symptoms can also happen in your arm or tummy if that’s where the blood clot is.

More information about DVT

• Watch this video about how to prevent DVT
• Learn more about DVT including symptoms, who is at risk and how to treat it on the NHS website
• Find out how to reduce the risk of blood clots when you have an immobilised lower limb (PDF, 108KB).

Pressure Sores and Ulcers

Plaster casts and not moving your limb can lead to pressure sores or ulcers. These are injuries to the skin and underlying tissue caused by prolonged pressure, rubbing or tension.

They often develop gradually, but can sometimes form in a few hours.

Signs and symptoms of a pressure sore include:

• skin discolouration – red patches for people with pale skin, purple or blue patches for people with dark skin
• discoloured patches that do not turn white when pressed
• a patch of skin that feels warm, spongy or hard
• pain or itchiness in the affected area.

Take your brace off every day to check your skin. Make sure it’s not rubbing.

More information about pressure sores and ulcers

• Watch this video about how to prevent pressure sores
• Read more about pressure sores on the NHS website

If you think you have a pressure sore or ulcer

Call the Fracture Clinic straight away on 01872 253091. For out of hours advice please call 01736 758909.

Sepsis

Sepsis (also known as blood poisoning) is a serious infection that can be life threatening. There is no one sign for sepsis so it can be hard to spot.

Call 111 immediately if you develop any of the following:

• Slurred speech or confusion
• Extreme shivering or muscle pain
• Passing no urine in a day
• Severe breathlessness
• It feels like you’re going to die
• Skin is mottled or discoloured.

Find out more about the symptoms of sepsis on the NHS website.

These videos also explain what Sepsis is and how to spot the early signs.

Work

Decisions to return to work are made on a unique basis and should be discussed with the Fracture Clinic, your GP and your employer.

You may need time off work and when you return, you may need light or amended duties. When you should return to work will depend on your profession and your injury.

You can get a fitness to work statement or a sick note when you come into the Fracture Clinic. If you don’t need to come and see us, you can get one from your GP.

Driving

Wait at least two weeks after your injury or surgery. After that, you can return to driving when:

• you have been told you no longer need your sling
• we’ve removed your cast (if you had one)
• you’re able to turn the steering wheel comfortably and without any pain
• you can control the vehicle safely
• you’ve checked it’s ok to drive with your insurance company.

Always test your ability to drive with the ignition off and in a safe environment.

If you have a follow up appointment with us, please wait until your consultant or physiotherapist has given you clearance to drive. If you are in any doubt, do not drive until you have spoken to our team.

Sport

You should not do any sports or heavy lifting for at least 12 weeks, but possibly longer, depending on your injury.