Plastic deformation of the forearm in adults: an analysis of 30 cases

BACKGROUND Plastic deformation of the forearm is a rare and frequently missed injury in adults that can result in a significant loss of forearm rotation. The condition is reported mainly in Western countries; however, it is not uncommon in Eastern developing countries. We conducted a retrospective study of 30 cases of forearm deformation to find common factors to increase awareness of the condition in trauma doctors. METHODS We analyzed 30 cases of forearm plastic deformation in adult patients first diagnosed and treated at the Orthopedic Department of our hospital between January 2000 and June 2012. Patients' age, injury mechanism, therapeutic process, and forearm rotation function were recorded for further analysis. RESULTS The average patient age was 21.3 years (range, 17-24 years), and the most common injury occurred at the right forearm in 29 patients (96.7%) when the arm became trapped in a machine with moving rollers. The remaining patient was injured while skiing. Twelve patients had a radial or ulnar fracture, 16 patients sustained no fracture, one patient had both radial and ulnar fractures, and one patient had an ipsilateral humeral fracture. Thirteen patients agreed to surgical osteotomy to reset the fracture or the distal/proximal radioulnar joint dislocation. All patients obtained good forearm function postoperatively, with an average pronation of 77° and supination of 78°. One patient refused surgical treatment, which led to forearm deformity and dysfunctional rotation. CONCLUSIONS We found that adult patients with forearm plastic deformation had similar age (17-24 years) and injury mechanism (entrapment in moving rollers in machines). In cases where the resulting ulnar or radial fractures and the distal/proximal radioulnar dislocation cannot be reset, we advise surgical osteotomy.