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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.