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Indications and timing for orthopedic referral of forearm fractures in adults

Indications and timing for orthopedic referral of forearm fractures in adults
IMMEDIATE (<1 hour) URGENT (<24 hours) Priority (24 to 72 hours)
Arterial compromise (eg, severed artery) Ulnar shaft fracture with <50% apposition or >10 degrees angulation Isolated radial shaft fracture with any displacement
Open fracture Forearm fracture with any DRUJ or PRUJ instability Both-bones fracture, even with minimal or no displacement
Symptoms or signs of acute compartment syndrome Both-bones fracture with displacement Isolated proximal third ulna fracture
    Forearm fracture with suspected peripheral nerve injury but no arterial compromise

DRUJ: distal radioulnar joint; PRUJ: proximal radioulnar joint.

* The large majority of forearm fractures should be managed by orthopedic surgeons, in part because many are unstable and require surgical fixation. The injuries described here require more rapid orthopedic consultation.
Graphic 101314 Version 2.0

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