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Acceptable Reduction for Pediatric Both Bone Forearm Frx

(see also: Technique of Reduction)

Discussion

initial considerationsBBFAC1

  • angular / rotational deformity: (growth will not correct rotational deformity)
  • age
  • 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

  • up to 15 deg of angulation is acceptable, especially if frx is distal;
  • 5 deg of rotation may also be acceptable;

between ages of 6-10 yrsBBFAC2

  • 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

BBFFR3 BBFFR4BBFFR5BBFFR6

 

 

 

 

References