Executive Editor: James Hunter General Editor: Fergal Monsell

Authors: Andrew Howard, Peter Schmittenbecher, Theddy Slongo

Pediatric proximal forearm

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Glossary

21r-E/1.1 - Radius, Salter-Harris I

Please select a treatment option:
Treatment Main indication Skill Equipment
Sling immobilization Minimally displaced, stable fracture, compliant patient Basic surgical experience, no specialized skills Basic equipment only
Cast immobilization Minimally displaced, stable fracture, uncompliant patient Basic surgical experience, no specialized skills Basic equipment only
Splint immobilization Minimally displaced, stable fracture, uncompliant patient Basic surgical experience, no specialized skills Basic equipment only
ESIN Any unstable or displaced fracture Some specialized surgical experience Simple surgical and imaging resources
Open reduction; K-wire fixation Displaced fracture, closed reduction impossible or image intensifier not available, implants for ESIN technique not available Highly experienced and skilled surgeon Simple surgical and imaging resources

21r-E/2 - Radius, Salter-Harris II

Please select a treatment option:
Treatment Main indication Skill Equipment
Sling immobilization Minimally displaced, stable fracture, compliant patient Basic surgical experience, no specialized skills Basic equipment only
Cast immobilization Minimally displaced, stable fracture, uncompliant patient Basic surgical experience, no specialized skills Basic equipment only
Splint immobilization Minimally displaced, stable fracture, uncompliant patient Basic surgical experience, no specialized skills Basic equipment only
ESIN Any unstable or displaced fracture Some specialized surgical experience Simple surgical and imaging resources
Open reduction; K-wire fixation Displaced fracture, closed reduction impossible or image intensifier not available, implants for ESIN technique not available Highly experienced and skilled surgeon Simple surgical and imaging resources

21r-E/3 + 21r-E/4 - Radius, Salter-Harris III + IV

Please select a treatment option:
Treatment Main indication Skill Equipment
Sling immobilization Minimally displaced, stable fracture, compliant patient Basic surgical experience, no specialized skills Basic equipment only
Cast immobilization Minimally displaced, stable fracture, uncompliant patient Basic surgical experience, no specialized skills Basic equipment only
Splint immobilization Minimally displaced, stable fracture, uncompliant patient Basic surgical experience, no specialized skills Basic equipment only
Open reduction; screw fixation Displaced or unstable fracture Highly experienced and skilled surgeon Simple surgical and imaging resources

21r-M/2.1 - Radius, metaphyseal, torus/buckle

Please select a treatment option:
Treatment Main indication Skill Equipment
Sling immobilization Compliant patient Basic surgical experience, no specialized skills Basic equipment only
Cast immobilization Uncompliant patient Basic surgical experience, no specialized skills Basic equipment only
Splint immobilization Uncompliant patient Basic surgical experience, no specialized skills Basic equipment only

21r-M/3 - Radius, metaphyseal, complete

Please select a treatment option:
Treatment Main indication Skill Equipment
Sling immobilization Minimally displaced, stable fracture, compliant patient Basic surgical experience, no specialized skills Basic equipment only
Cast immobilization Minimally displaced, stable fracture, uncompliant patient Basic surgical experience, no specialized skills Basic equipment only
Splint immobilization Minimally displaced, stable fracture, uncompliant patient Basic surgical experience, no specialized skills Basic equipment only
ESIN Any unstable or displaced fracture Some specialized surgical experience Simple surgical and imaging resources
Open reduction; K-wire fixation Displaced fracture, closed reduction impossible or image intensifier not available, implants for ESIN technique not available Highly experienced and skilled surgeon Simple surgical and imaging resources

21u-M/2 - Ulna, torus/buckle + incomplete

Please select a treatment option:
Treatment Main indication Skill Equipment
Sling immobilization Minimally angulated fracture, compliant patient Basic surgical experience, no specialized skills Basic equipment only
Cast immobilization Minimally angulated fracture, uncompliant patient Basic surgical experience, no specialized skills Basic equipment only
Splint immobilization Minimally angulated fracture, uncompliant patient Basic surgical experience, no specialized skills Basic equipment only

21u-M/3 - Ulna, complete

Please select a treatment option:
Treatment Main indication Skill Equipment
Sling immobilization Minimally displaced, stable fracture, compliant patient Basic surgical experience, no specialized skills Basic equipment only
Cast immobilization Minimally displaced, stable fracture, uncompliant patient Basic surgical experience, no specialized skills Basic equipment only
Splint immobilization Minimally displaced, stable fracture, uncompliant patient Basic surgical experience, no specialized skills Basic equipment only
Open reduction; tension band fixation Displaced single transverse fracture in the olecranon without comminution Some specialized surgical experience Simple surgical and imaging resources
Open reduction; plate fixation Displaced fracture, multifragmentary or comminuted and unsuitable for tension band wiring Some specialized surgical experience Full specialized surgical and imaging resources

21u-M/7 - Ulna, avulsion of apophysis

Please select a treatment option:
Treatment Main indication Skill Equipment
Sling immobilization Minimally displaced, stable fracture, compliant patient Basic surgical experience, no specialized skills Basic equipment only
Cast immobilization Minimally displaced, stable fracture, uncompliant patient Basic surgical experience, no specialized skills Basic equipment only
Splint immobilization Minimally displaced, stable fracture, uncompliant patient Basic surgical experience, no specialized skills Basic equipment only
Open reduction; tension band fixation Displaced fracture Some specialized surgical experience Simple surgical and imaging resources

21u-M/7 - Ulna, avulsion of coronoid

Please select a treatment option:
Treatment Main indication Skill Equipment
Sling immobilization Small coronoid avulsion, compliant patient Basic surgical experience, no specialized skills Basic equipment only
Cast immobilization Small coronoid avulsion, uncompliant patient Basic surgical experience, no specialized skills Basic equipment only
Splint immobilization Small coronoid avulsion, uncompliant patient Basic surgical experience, no specialized skills Basic equipment only

21u-M/6.1 - Monteggia lesion

Please select a treatment option:
Treatment Main indication Skill Equipment
Closed reduction; cast immobilization Young child, fracture manipulation leading to stable ulnar fracture and reduced and stable radiocapitellar joint possible Some specialized surgical experience Basic equipment only
ESIN Any unstable or displaced fracture Some specialized surgical experience Simple surgical and imaging resources
Open reduction; plate fixation Insufficient stability to hold radial head reduced, unstable injury in adolescents and young adults Highly experienced and skilled surgeon Full specialized surgical and imaging resources

21r-E/M, 21u-M - Monteggia equivalent

Please select a treatment option:
Treatment Main indication Skill Equipment
ESIN Any unstable or displaced fracture Some specialized surgical experience Simple surgical and imaging resources
Open reduction; plate fixation (ulna) Unstable injury in adolescents and young adults Highly experienced and skilled surgeon Full specialized surgical and imaging resources

21r-E/M, 21u-M Radial head/neck + olecranon fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Open reduction; internal fixation Any combination of olecranon and radial head/neck fracture Some specialized surgical experience Simple surgical and imaging resources
*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