The Injured Forearm

This session included presentations on: Forearm stiffness, including: Radial head problems; and DRUJ problems; and Forearm instability, including: Ulnar head; Acute longitudinal instability. What needs repairing?; and Chronic Essex-Lopresti reconstruction.

The anatomy of the forearm is complex, both at the elbow and at the distal radioulnar joint (DRUJ). Forearm stiffness can be due to proximal or distal problems and it is not always easy to determine which is the cause. At the radial head, fixation following trauma is best (if three fragments or fewer) otherwise replacement is needed, which is difficult to get right. The aim is to reproduce the natural anatomy and early movement is encouraged. At the DRUJ, soft-tissue problems in a congruent joint are initially treated non-operatively, whereas an incongruent joint will require surgery. Forearm stiffness due to bony deformity, synostosis or osteophytes requires correction of the abnormal bone.

Forearm stability is very important in sport. Instability at the ulnar head can be diagnosed by a difference in the surface contour of the ulnar head. The TFCC is key for providing stability, although tears/detachment can be hard to see on imaging – exploratory arthroscopy is useful. Reattachment of the TFCC works well but a long period of post-operative therapy is needed. The interosseous membrane is crucial for providing longitudinal stability and injury to it (Essex-Lopresti) is very rare; however, maintain a high index of suspicion as the outcome of late detection is very poor. There are promising early results for chronic cases using LARS, but return to sport is not possible.

The anatomy of the forearm is complex, both at the elbow and at the distal radioulnar joint
Regarding peri-symphyseal anatomy, it is important to think in layers