Annual Report

General Editor: Chris Colton

Authors: Fergal Monsell, Dalia Sepulveda

Pediatric distal forearm 23u-E/2.1

back to Pediatric overview

Glossary

General considerations

Simple casting is the most frequent and usually successful treatment option for these injuries. Closed reduction of these injuries is not frequently required.

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".

Splint
Main indication Skill Equipment
Undisplaced fracture Basic surgical experience, no specialized skills Basic equipment only

Supporting indications

  • Swollen wrist
  • Local soft tissue compromise
  • Compliant patient and parent/carers

Advantages

  • Requires no special expertise
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 the three-point molding principle

Disadvantages

  • Requires skilled practitioner
  • Need for more frequent monitoring
Closed reduction; 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 principle

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 implant 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