Internal fixation in the treatment of fractures of the shafts of the radius and ulna in adults; the value of delayed operation in the prevention of non-union.

A good reduction may not be obtained or may be lost when the initial swelling subsides. Union of these fractures is often slow and a period of four or five months in plaster is often necessary. There is with conservative, as with operative, treatment a definite incidence of non-union, which with conservative treatment is about 6 per cent. When union is slow a gradual deterioration in position can occur over a period of weeks or months, sometimes necessitating a late operation which can be difficult and unsatisfactory. Despite these limitations, conservative treatment is the method of choice for patients in whom reduction can be obtained and maintained. It is undesirable to compare the results of conservative with those of operative treatment because the latter should generally be used only for fractures not suitable for conservative measures, or when those measures have failed. Precise indications for operation cannot easily be laid down and may be misleading. The surgeon who is not prepared to make full use of both methods cannot give of his best in the treatment of these difficult fractures. The principles of conservative treatment were well described by Evans in 1951. This paper will in some ways be complementary to that report because it describes the experience gained in a series of forearm fractures treated by internal fixation.