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Pediatric Distal Radius Fracture

- Discussion:
    - 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:

 - Anesthesia:
     - 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;
   - technique:
            - 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;
    - reference:
            - 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 
    - references:
           - 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

- Immobilization of Distal Radius:
      - references:
            - 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;

     - references:
             - 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.

- Complications