# Forearm Fractures

> Forearm fractures for NEET-PG Orthopaedics: both-bone injuries, Monteggia and Galeazzi fracture-dislocations, plating and nerve palsies, with exam points.

- Canonical URL: https://prepelephant.com/topics/neet-pg/orthopaedics/forearm-fractures
- Exam / course: NEET-PG · Subject: Orthopaedics
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-02
- Last updated: 2026-10-02
- How to cite: "Forearm Fractures", PrepElephant, https://prepelephant.com/topics/neet-pg/orthopaedics/forearm-fractures

## Direct answer

Forearm fractures matter because the radius and ulna form a joint-like unit that rotates around each other, so both-bone fractures in adults behave like intra-articular injuries and are almost always treated by open reduction and internal fixation with plates. Two eponymous patterns pair a single broken bone with a dislocated joint at the other end — Monteggia (ulna shaft with radial head dislocation) and Galeazzi (radial shaft with distal radio-ulnar disruption) — and both are missed when the second joint is not imaged.

## What you must remember

- **Both-bone fractures in adults** need anatomical open reduction and plating of both bones, because even small angulation erodes the interosseous space and costs pronation-supination; conservative treatment is the exception, not the rule.
- **Monteggia fracture-dislocation:** fracture of the proximal ulna with dislocation of the radial head; Bado type I — anterior dislocation — is the commonest; the posterior interosseous nerve is at risk and its palsy may present as drop fingers without wrist drop, since the extensor carpi radialis is spared.
- **Galeazzi fracture-dislocation:** fracture of the radial shaft, classically at the junction of the middle and distal thirds, with disruption of the distal radio-ulnar joint; famously the "fracture of necessity" because it needs operative fixation.
- **Isolated ulna shaft (nightstick) fracture:** from a direct blow, treated conservatively in a cast or brace if undisplaced.
- **Radial shaft level decides fragment posture:** above the supinator insertion the proximal fragment supinates; below pronator teres the supinators and pronators partly balance, which is why level determines the reduction position.
- **In children,** plastic deformation, greenstick and complete fractures dominate, and remodelling allows conservative management of many angulated fractures that would be plated in adults.
- **Essex-Lopresti injury:** radial head fracture with distal radio-ulnar disruption and interosseous membrane damage — the proximal cousin of Galeazzi.

## Common confusion

The eponymes are swapped in a hurry, so anchor them anatomically: Monteggia breaks the ulna and dislocates proximally at the elbow; Galeazzi breaks the radius and disrupts the wrist-side distal radio-ulnar joint. A simple frame — Monteggia: ulna, elbow; Galeazzi: radius, wrist — prevents most errors. The second trap is satisfaction of search: an apparently isolated forearm fracture demands films of the elbow and wrist, or the dislocated radial head or distal radio-ulnar joint is missed until stiffness sets in.

## Exam-focused takeaway

NEET-PG leans on recognition vignettes: a proximal ulna fracture asks for elbow films to catch Monteggia's dislocated radial head, and wrist pain with a radial shaft fracture points to Galeazzi. Nerve stems test the posterior interosseous nerve of Monteggia as a motor-only palsy — wrist extension preserved, fingers dropped, no sensory loss. Management answers pair adult both-bone and Galeazzi fractures with open plating and children's greenstick fractures with closed reduction, with one-liners on the nightstick fracture and the Essex-Lopresti combination.

## Frequently asked questions

### What is a Monteggia fracture-dislocation?

A fracture of the proximal ulna with dislocation of the radial head, commonest in Bado type I with anterior dislocation, complicated by posterior interosseous nerve palsy.

### What is a Galeazzi fracture-dislocation?

A fracture of the radial shaft at the junction of its middle and distal thirds with disruption of the distal radio-ulnar joint, treated by open reduction and plating.

### Why must adult both-bone forearm fractures be fixed operatively?

The forearm rotates as a unit, so residual angulation narrows the interosseous space and permanently restricts pronation and supination.

### Which nerve is at risk in a Monteggia injury?

The posterior interosseous nerve, causing finger and thumb extension weakness without sensory loss, often recovering after reduction.

### What is a nightstick fracture?

An isolated, usually undisplaced fracture of the ulna shaft from a direct blow, generally managed conservatively.