General Editor: Chris Colton

Authors: Fergal Monsell, Dalia Sepulveda

Pediatric distal forearm 23-M/3.1

General considerations

Complete radial and ulnar fractures tend to occur in children above 5 years of age.

The periosteum is either partially or totally disrupted and will influence the choice of treatment. In case of minor posterior angulation, the posterior periosteum will be intact whereas the anterior periosteum will be torn). The degree of angulation and the bone age of the child determine the tolerance for accepting residual malalignment.

Nonoperative management is the most frequent and the most successful treatment option, independent of displacement. Casting should respect the three point fixation principle.

If reduction fails to achieve an acceptable position operative treatment may be indicated. In the first instance this is likely to be closed reduction under general anesthesia and percutaneous fixation with K-wires. In open fractures, the use of an external fixator may be considered.

Open reduction might be necessary if the periosteum, or quadratus muscle, is interposed preventing a successful closed reduction. In patients near skeletal maturity, open reduction and plate fixation, as used in adults, is an option.

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v1.0 2016-12-01