- 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.
