Answer no.

5 :
Non-operative treatment of both bone forearm fractures in the pediatric population is common
and typically results in a good to excellent outcome.[13] However, non-operative treatment of adult
forearm fractures is very rarely indicated, and the comparison of non-operative to operative
treatment in the literature is scarce.[14] Isolated radial shaft fractures usually require surgical fixation
to maintain adequate anatomic alignment and rotation.

Isolated minimal or nondisplaced ulnar shaft fractures can be treated nonoperatively with casting or
functional bracing and close followup and serial examinations. Because most both bone forearm
fractures require surgery, initial reduction and immobilization should be performed with the goal of
best preparing the patient for surgery.

For significantly displaced fracture, procedural sedation can be utilized to reduce the fracture and
apply a splint properly. Open fractures should be reduced, thoroughly irrigated, and antibiotics
started as soon as possible. Standard immobilization is achieved using a sugar-tong splint with the
forearm in neutral rotation, and the elbow flexed to 90 degrees. Surgical treatment options include
open reduction internal fixation (ORIF) and intramedullary nailing. Shorter intraoperative times and
decreased scarring are observed benefits following fixation with intramedullary nailing.[15] However,
achieving rotational stability as well as restoration of the radial bow is difficult with the use of
intramedullary nailing. ORIF with plate and screw construct is generally accepted as the gold standard
for treatment.[16] Comparison of ORIF and intramedullary nailing has been inconclusive.[17][18] 

Some studies suggest that a hybrid fixation method of plate fixation of radius and intramedullary
nailing of the ulna is a better approach as it shows good stability, fewer complications, and  good
clinical outcomes.[19] The type of plate and screw construct is typically dictated by the fracture
pattern. For oblique or transverse fractures, compression plating is often utilized to achieve
compression at the fracture site and promote primary bone healing. In the setting of long oblique or
spiral fracture patterns, interfragmentary screws are utilized to provide compression at the fracture
site, and a spanning plate is applied for neutralization.

Finally, bridge plating techniques are utilized for fractures with significant comminution, and when
interfragmentary compression is unattainable. The goal of any fixation method is to  achieve anatomic
length, alignment, and rotation across the fracture site. Bone grafting is often utilized if segmental
defects are present. However, its effect with regards to fracture union is debated.[20][21]  Open
fractures are classified using the Gustilo-Anderson classification system. Prompt administration of
antibiotics is critical in the management of open fractures. Irrigation and debridement at the time of
fixation are indicated for all open fractures. The amount of soft tissue damage may dictate the type of
fixation method chosen. For example, Gustilo-Anderson IIIB open fractures with large soft tissue
defects may require temporary external fixation prior to definitive fixation and skin coverage.

Reference :
13. Hadizie D, Munajat I. Both-Bone Forearm Fractures in Children with Minimum Four Years of
Growth Remaining: Can Cast Achieve a Good Outcome at Skeletal Maturity? Malays Orthop J. 2017
Nov;11(3):1-9. [PMC free article] [PubMed]
14. Schulte LM, Meals CG, Neviaser RJ. Management of adult diaphyseal both-bone forearm
fractures. J Am Acad Orthop Surg. 2014 Jul;22(7):437-46. [PubMed]
15. Zhao L, Wang B, Bai X, Liu Z, Gao H, Li Y. Plate Fixation Versus Intramedullary Nailing for Both-Bone
Forearm Fractures: A Meta-analysis of Randomized Controlled Trials and Cohort Studies. World J
Surg. 2017 Mar;41(3):722-733. [PubMed]
16. Iacobellis C, Biz C. Plating in diaphyseal fractures of the forearm. Acta Biomed. 2014 Jan
23;84(3):202-11. [PubMed]
17. Street DM. Intramedullary forearm nailing. Cl