Orthopaedic Surgery - MUA and ORIF of radius and ulna (plate and screws to fix both forearm bones)

Procedure

Your forearm bones (called the radius and ulna) are broken. Your surgeon feels that they would heal best if both fixed and held in position by plate and screws.

Usually, you will be put to sleep (general anaesthetic) although sometimes, the anaesthetic doctor may perform a regional block (when an area is numbed but you remain awake). You must discuss this with your anaesthetist.

When in theatre, you will lay on your back with your arm outstretched. There are two bones broken and most surgeons make two cuts (incisions) to get to the bones. One will be on the front of the forearm and the other on the back. The size and exact position depend on you breaks.

The surgeon must move muscle, tendons and delicately move blood vessels and nerves out of the way to get to the bone.

Once there, your surgeon will position the ends in as close to normal position is possible and hold them with a plate and screws.

When happy, the surgeon will start to close up the arm. Special skin stitches are used (sutures) these may dissolvable under the skin or above the skin. Those left above the skin will need to be removed at 10 to 14 days. Check with your surgeon.
 
Often the surgeon likes to keep the arm in a plaster for added protection. The time in a plaster depends upon the type of break and the surgeon.

You will be encouraged to keep your arm held high (elevated) after the operation - this is important as it keeps the swelling down.

Please be aware that a surgeon other than the consultant, but with adequate training or supervision may perform the operation.

Alternative procedure

The fracture may be left in its current position in a plaster. If it is not in a good solid position, it may not heal as well or the function of your elbow, forearm or wrist may be affected. This will make it more likely to cause, arthritis, pain and disability.

You may of course seek a second opinion.

There may be other forms of fixation, such as wiring or external fixators. These may not be appropriate for your case. You should discuss these with your consultant.

Risks

As with all procedures this carries some risks and complications.

Common (1-5%) Pain

Your wrist will be sore after the operation. Keeping the arm up (elevated) most of the time will help reduce the pain and swelling. We will also give you pain killers. If you need more, however, please ask a member of staff.

Bleeding

There will almost certainly be some bleeding. This is usually small spotting and will stop itself. Very rarely, a blood vessel is damaged and there is more bleeding, or it may form a clot. This may need a second operation to stop the bleeding or remove the clot.

Rare (<1%) Infection

Unfortunately, even though the surgeon inserts the plate in theatre where everything is sterile and your skin is cleaned, there is still a small percent of patients who develop an infection. Most infections will present as redness, swelling or even a discharge of fluid or pus. A course of antibiotic may be needed. If the infection is severe, a further operation including removal of plate may be necessary.

Neurovascular damage

There are numerous blood vessels and nerves that run through and around the wrist. This means that they may be damaged by the plate as it is put in. This might lead to numbness or weakness of muscles. This may be temporary or in very rare cases, permanent.

Compartment Syndrome

This is a build-up pressure within the forearm and can cause pain, nerve damage, blood vessel damage and muscle damage. If this occurs, an emergency operation will have to be performed.

Slipped position

Despite manipulation, plating and cast application, the fracture may very rarely still slip. Further operation may be necessary.

Removal of metalwork

This is not usually necessary in adults unless there is pain, infection or severe restriction in movement or irritating the skin.

Arthritis

And stiffness at the wrist or elbow may occur despite adequate reduction. Arthritis may be more common if the fracture involves the joint.

CRP Syndrome

This is pain, swelling or stiffness around the fracture site and may occur even months after the original injury.

Re-break

The bones can re-break.