Periosteal reaction on later radiographs may not occur with bowing fractures so this cannot be used as a criterion to rule out an earlier fracture. A comparison view of the other extremity may be useful in identifying the bowing fracture. View comparison of the other forearm. This comparison view shows the normal configuration of the unaffected right radius and ulna on the right image. However, note that the two are not very different since the bowing of the left ulna is not severe.
Arrows point to the bowing deformity of the ulna.
Examine the left forearm in isolation. See if you can appreciate the bowing deformity of the ulna. In this case, the clinical appearance of a deformed forearm is highly indicative of a fracture. If radiographs fail to confirm the presence of an obvious fracture, consider the possibility of a bowing fracture. In Ped Emerg Med Case Selection Page Return to Univ.