General Editor: Chris Colton

Authors: Fergal Monsell, Dalia Sepulveda

Pediatric distal forearm 23r-E/2.1

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Glossary

General considerations

Simple casting, with or without closed reduction, is the most frequent and usually successful treatment option for these injuries.

Casting should always respect the three-point fixation/molding principle.

Note: Be aware of nonaccidental injuries in very young children with fractures around the physis. Small metaphyseal fragments in infants with this injury are sometimes referred to as "corner fractures".

Short or long arm cast
Main indication Skill Equipment
Undisplaced fractures Basic surgical experience, no specialized skills Basic equipment only

Contraindications

  • Local soft tissue compromise

Advantages

  • Maintains the original fracture position using three-point molding

Disadvantages

  • Requires skilled practitioner
  • Need for more frequent monitoring
Closed reduction; Short or long arm cast
Main indication Skill Equipment
Displaced injuries Basic surgical experience, no specialized skills Basic equipment only

Contraindications

  • Patients seen later than 7 days after the injury
  • Local soft tissue compromise including open fractures

Advantages

  • Maintains the reduction using three-point molding

Disadvantages

  • Requires skilled practitioner
  • Need for more frequent monitoring
Closed reduction; K-wire fixation
Main indication Skill Equipment
Displaced injuries Basic surgical experience, no specialized skills Basic equipment only

Contraindications

  • Patients seen later than 7 days after the injury
  • Local soft tissue compromise, including open fractures

Advantages

  • Maintains the reduction

Disadvantages

  • Requires skilled practitioner and surgical resources
  • Potential for pin-track infection
  • Requires implant removal
Open reduction; K-wire fixation
Main indication Skill Equipment
Irreducible major displacement Some specialized surgical experience Simple surgical and imaging resources

Advantages

  • Allows direct anatomical reduction
  • Prevents secondary displacement

Disadvantages

  • Requires skilled practitioner and full surgical facilities
  • Risk of soft tissue compression if cast is not split
  • Risk of pin-track problems and need for removal
External fixation
Main indication Skill Equipment
Open fracture (Gustilo II or III) and/or polytrauma Some specialized surgical experience Simple surgical and imaging resources

Advantages

  • Rapid application in polytrauma
  • Allows definitive cast-free management of soft tissues, fracture and pain
  • Allows correction of secondary malalignment

Disadvantages

  • Requires skilled practitioner and full surgical facilities
  • Risk of pin-track problems and need for removal
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2016-12-01