Forearm fractures in the head-injured adult

Forty-seven of 661 head-injured adults sustained 50 forearm fractures. Eight extremities exhibited elbow flexion contractures greater than 55 degrees. Traumatic heterotopic ossification at the elbow developed in ten (20%) extremities: four with Monteggia fractures, two with olecranon fractures, and four with no known trauma. Only two of 18 (11%) extremities treated by plaster immobilization achieved good or excellent results, while 17 of 32 (53%) extremities treated by open reduction and internal fixation achieved good or excellent results. Union of fractures of one or both bones occurred at the same rate as for the normal population. There were no nonunions or deep infections, and there was only one delayed union. Calcification occurred in the interosseous membrane in 12 extremities (24%). In nine forearms (18%) a complete synostosis developed. One isolated radial fracture treated by open reduction and internal fixation and one isolated ulnar fracture treated by plaster incurred a synostosis. Seven of 21 (33%) fractures of both bones developed synostosis. Five of 16 (31%) fractures of both bones treated by open reduction and internal fixation developed a synostosis. These observations corroborate reports demonstrating that head injury predisposes to heterotopic ossification in forearm fractures.