Executive Editor: James Hunter General Editor: Fergal Monsell

Authors: Andrew Howard, Peter Schmittenbecher, Theddy Slongo

Pediatric proximal forearm 21u-M/2

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Glossary

General considerations

Thick periosteum at this anatomical site acts as a tension band in flexion of the elbow.

This undisplaced fracture is therefore stable and may be treated by immobilization only.

Take care to confirm that the intraarticular injury is truly undisplaced.

The type of immobilization depends on the pain and the compliance of the child/parents and the age of the patient.

Injuries distal to the coronoid may be accompanied by radial head dislocation or injury. (See Monteggia lesion and Monteggia equivalent.)

Sling immobilization
Main indication Skill Equipment
Minimally angulated fracture, compliant patient Basic surgical experience, no specialized skills Basic equipment only

Advantages

  • Comfortable
  • Good radiological access
  • Avoidance of joint stiffness
  • Early functional treatment
Cast immobilization
Main indication Skill Equipment
Minimally angulated fracture, uncompliant patient Basic surgical experience, no specialized skills Basic equipment only

Contraindications

  • Severe swelling
  • Skin lesions

Advantages

  • Cannot be removed by patient/parent

Disadvantages

  • Joint stiffness
Splint immobilization
Main indication Skill Equipment
Minimally angulated fracture, uncompliant patient Basic surgical experience, no specialized skills Basic equipment only

Supporting indications

  • Swelling and pain
  • Skin lesions

Advantages

  • Removable for skin care
  • Removable if pain or neurovascular problems develop
*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 2019-08-28