Acceptable Reduction for Pediatric Both Bone Forearm Frx
- See: Technique of Reduction
- initial considerations:
- angular / rotational deformity: (growth will not correct rotational deformity)
- distance from physis
- direction of angulation
- amount of deformity
- bayonette apposition
- generally bayonette opposition will require operative reduction (either closed with a Kapandji K wire levering technique or in some situations, an open reduction and fixation with K wires will be required);
- historically, overriding of a both bones forearm fracture was acceptable if...
- there was no deviation of radius and ulna toward each other;
- there was no encroachment of the interosseous space;
- pt is less than 10 yrs of age;
- in pts < 6 yrs of age:
- upto 15 deg of angulation is acceptable, especially if frx is distal;
- 5 deg of rotation may also be acceptable;
- between ages of 6-10 yrs:
- less than 10 deg of angulation should remodel especially if frx is close to distal epiphysis;
- bayonet apposition may be acceptable, although end to end apposition is preferred;
- acceptable angulation is less than 15 deg, however, even more angulation may be preferable to resorting to open reduction;
- this is especially true if the reduction allows physiologic pronation and supination;
- pts > 12 yrs of age:
- no angulatory or rotational deformity is considered acceptable;
- more aggressive treatment is required, including open reduction and compression plating may be required;
- Displaced Distal Third Frx:
- angulation up to 20-25 deg during first ten years is OK;
- angulation > 10 deg is unlikely to correct after 10 yrs
The effects of angular and rotational deformities of both bones of the forearm. An in vitro study.
Remodelling potential of the growth plate following angular osteotomy of the long bones in baboons. Abraham E, Groya RJ: Trans Orthop Res Soc 1981;6:266.
Angular remodeling of midshaft forearm fractures in children.
Spontaneous correction of deformity following fractures of the forearm in children.
Accurate prediction of outcome after pediatric forearm fracture.
Bowing fractures of the forearm in children: a long-term followup.
Closed Treatment of Overriding Distal Radial Fractures without Reduction in Children
Original Text by Clifford R. Wheeless, III, MD.
Last updated by Data Trace Staff on Thursday, August 9, 2012 10:14 am