Pediatric Distal Radius Fracture
- children's frx are rarely intra-articular;
- common types:
- physeal frx
- torus fracture
- green stick frx
- both bone forearm frx
- galeazzi's frx
- distal radius fracture:
- note that in children, the term "IV sedation" should be changed to "IV anesthesia," since any amount of IV sedatives are potentially dangerous;
- determine when the child last ate;
- realize that a painful fracture can cause a gastric ileus, and therefore, waiting 8 hours before administering IV anesthetics does not at all guarentee that
the child's stomach will be empty;
- Closed Reduction:
- note: completely displaced fractures are 7 times more likely to redisplace than fractures with some bony contact or no translation;
- pure traction may actually make it more difficult to oppose the frx ends due to tightening of the overlying periosteum (like a chinese finger trap);
- distal radius is hyperextended and the distal fragment is pushed distally until the dorsal cortex is out to length;
- distal fragment is then "hinged over" the frx site;
- if closed reduction is still not possible, then insert a 1 mm K wire percutaneously into fracture site and use it "lever" the fracture into a reduced position;
- Closed reduction of fractures of the proximal radius in children.
- Distal Radial Fractures in Children: Risk Factors for Redisplacement Following Closed Reduction
- Acceptable Reduction:
- see accetable reduction in both bone forearm frx
- Remodelling after distal forearm fractures in children. II. The final orientation of the distal and proximal epiphyseal plates of the radius.
- Remodelling after distal forearm fractures in children. III. Correction of residual angulation in fractures of the radius.
- Remodeling of angulated distal forearm fractures in children.
- Translation of the radius as a predictor of outcome in distal radial fractures of children.
- Risk Factors in Redisplacement of Distal Radial Fractures in Children.
- Think twice before re-manipulating distal metaphyseal forearm fractures in children
- Immobilisation of forearm fractures in children: extended versus flexed elbow.
- Above and below-the-elbow plaster casts for distal forearm fractures in children. A randomized controlled trial.
- Comparison of Short and Long Arm Plaster Casts for Displaced Fractures in the Distal Third of the Forearm in Children.
- case example:
- 2 yr old male who sustained a simple distal radial torus frx;
- he was treated w/ a sugar tong splint, was sent home, and cried all night;
- several days later, it was apparent that he sustained a 3rd degree burn to the forearm, as well as a Volkman's ischemic contracture;
- Operative Treatment:
- note associated injuries: - condylar and supracondylar frx;
- w/ bayonete opposition, the child should receive general anesthesia with closed reduction and pin fixation;
- if closed reduction is not possible, then insert a 1 mm K wire percutaneously into fracture site and use it to "lever" the fracture into a reduced position;
- Compartmental syndrome complicating Salter-Harris type II distal radius fracture.
- Growth disturbance of the distal radial epiphysis after trauma: operative treatment by corrective radial osteotomy.
- Redisplacement after closed reduction of forearm fractures in children.
- Completely displaced distal radius fractures with intact ulnas in children.
- Management of completely displaced metaphyseal fractures of the distal radius in children. A prospective, randomised controlled trial.
Pattern of forearm fractures in children.
Use of pins and plaster in the treatment of unstable pediatric forearm fractures.
Team physician #5. Salter-Harris type I fracture of the distal radius due to weightlifting.
The Management of Isolated Distal Radius Fractures in Children.
Open fractures of the forearm in children.
Original Text by Clifford R. Wheeless, III, MD.
Last updated by Data Trace Staff on Friday, August 21, 2015 10:00 am