Closed Reduction of Both Bone Forearm Fractures

- Discussion:
    - unlike adults, both bones fractures in children can be treated closed w/ cast, however, it should be noted that the periosteal sleeve may be disrupted
            in these fractures making them relatively unstable;
    - technique of reduction:
    - following reduction an assessment of forearm pronation and supination should be performed;
    - arm should be placed in a long arm cast or splint;
    - midshaft fractures may be best held in proper alignment with the elbow extended, especially when the radial shaft frx is proximal to the ulnar shaft frx;
            - references:
                   - Mid third forearm fractures in children: an unorthodox treatment.  
                   - Forearm fractures treated in extension. Immobilization of fractures of the proximal both bones of the forearm in children
    - position of cast:
         - position of wrist in cast varies w/ position of fracture;
         - most proxial 1/3 frx need to be immobilized in supination;
         - most middle 1/3 frx should be placed in neutral;
         - most distal 1/3 frx require immobilization in pronation;
    - references:
         - Forearm fractures in children. Cast treatment with the elbow extended
         - Factors affecting fracture position at cast removal after pediatric forearm fracture
- Follow Up:
    - accetable reduction:
    - need follow-up radiographs at one & two-week intervals after initial reduction;
         - > 5% are subject to reangulation or displacement, but note that in mid shaft frx w/ radial frx proximal to ulnar frx, rate of redisplacement may be > 50%;
         - loss of acceptable alignment should be treated by remanipulation;
         - nonepiphyseal frxs may be safely manipulated up to 24 days postfrx;
    - frx at risk
         - frx of the distal radius along w/ concomitant ulnar green stick or torus frx, were noted to have significant displacement in the majority of cases;
                - these frx were best treated w/ initial percutaneous pinning, followed by casted;
    - references:
         - Redisplacement after closed reduction of forearm fractures in children.
         - Immobilisation of forearm fractures in children: extended versus flexed elbow.

A Comparison of Pediatric Forearm Fracture Reduction Between Conscious Sedation and General Anesthesia.

Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, March 28, 2012 12:10 pm