Executive Editor: James Hunter General Editor: Fergal Monsell

Authors: Andrew Howard, Peter Schmittenbecher, Theddy Slongo

Pediatric proximal forearm 21u-M/3

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Glossary

General considerations

Complete fractures of the proximal ulna may be minimally displaced or displaced.

They are potentially unstable and may need ORIF.

If the typical thick periosteum in the child is ruptured the tension band effect during flexion of the elbow is lost.

If operative treatment is not available, immobilization is indicated and depends on the age of the child, the level of pain and the compliance of the child/parents.

Injuries distal to the coronoid are sometimes associated with radial head dislocation or injury. (See Monteggia lesion and Monteggia equivalent.)

Sling immobilization
Main indication Skill Equipment
Minimally displaced, stable 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 displaced, stable 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

  • Loss of x-ray definition
  • Joint stiffness
Splint immobilization
Main indication Skill Equipment
Minimally displaced, stable 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
Open reduction; tension band fixation
Main indication Skill Equipment
Displaced single transverse fracture in the olecranon without comminution Some specialized surgical experience Simple surgical and imaging resources

Advantages

  • Cast-free treatment or short-term cast or splint immobilization

Disadvantages

  • Second general anesthetic for implant removal
  • Risk of infection
Open reduction; plate fixation
Main indication Skill Equipment
Displaced fracture, multifragmentary or comminuted and unsuitable for tension band wiring Some specialized surgical experience Full specialized surgical and imaging resources

Advantages

  • Cast-free treatment or short-term cast or splint immobilization

Disadvantages

  • Second general anesthetic for implant removal
  • Risk of infection
*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