Annual Report

General Editor: Chris Colton

Authors: Fergal Monsell, Dalia Sepulveda

Pediatric distal forearm 23r-M/3.2

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Glossary

General considerations

Operative treatment is usually the more appropriate.

Long arm cast
Main indication Skill Equipment
Undisplaced closed fracture Basic surgical experience, no specialized skills Basic equipment only

Contraindications

  • Local soft tissue compromise
  • Open fracture (Gustilo II or III)
  • Fracture angulated more than 15° and/or children older than 10 years

Disadvantages

  • Risk of secondary displacement
Closed reduction; Long arm cast
Main indication Skill Equipment
Displaced fractures in the absence of appropriate surgical resources Some specialized surgical experience Basic equipment only

Supporting indications

  • Closed and Gustilo I open fracture
  • Minimal displacement

Contraindications

  • Local soft tissue compromise

Disadvantages

  • High risk of secondary displacement
Closed reduction; K-wire fixation
Main indication Skill Equipment
Only one intermediate fragment Some specialized surgical experience Basic equipment only

Indications

  • Satisfactory closed reduction

Contraindications

  • Local soft tissue damage
  • Marked swelling

Advantages

  • Avoids an open surgical approach

Disadvantages

  • Risk of secondary displacement
Open reduction; K-wire fixation
Main indication Skill Equipment
Only one intermediate fragment and failure of closed reduction Some specialized surgical experience Simple surgical and imaging resources

Contraindications

  • Local soft tissue damage
  • Marked swelling

Disadvantages

  • Risk of secondary displacement
  • Closer monitoring required
External fixation
Main indication Skill Equipment
Excessive comminution and/or open fracture 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
Open reduction; Plate fixation
Main indication Skill Equipment
Displaced unstable fracture in adolescents Some specialized surgical experience Simple surgical and imaging resources

Relative contraindication

  • Skeletally immature patients

Advantages

  • Allows anatomical reduction
  • Prevents secondary displacement

Disadvantages

  • Requires skilled practitioner and full surgical facilities
*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