Pediatric Distal Radius Fracture : Wheeless' Textbook of Orthopaedics

- 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;