General Editor: Chris Colton

Authors: Fergal Monsell, Dalia Sepulveda

Pediatric distal forearm

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Glossary

23-M/2.1 - Metaphyseal, torus/buckle fractures, both bones

Please select a treatment option:
Treatment Main indication Skill Equipment
Splint Compliant children Basic surgical experience, no specialized skills Basic equipment only
Short or long arm cast Greenstick variant and/or high level of pain Basic surgical experience, no specialized skills Basic equipment only

23r-M/2.1 - Metaphyseal, torus/buckle fractures, radius

Please select a treatment option:
Treatment Main indication Skill Equipment
Splint Compliant children Basic surgical experience, no specialized skills Basic equipment only
Short or long arm cast Greenstick variant and/or high level of pain Basic surgical experience, no specialized skills Basic equipment only

23u-M/2.1 - Metaphyseal, torus/buckle fractures, ulna

Please select a treatment option:
Treatment Main indication Skill Equipment
Splint Compliant children Basic surgical experience, no specialized skills Basic equipment only
Short or long arm cast Greenstick variant and/or high level of pain Basic surgical experience, no specialized skills Basic equipment only

23-M/3.1 - Metaphyseal, simple complete, both bones

Please select a treatment option:
Treatment Main indication Skill Equipment
Long arm cast Minimally displaced and stable fractures Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; Long arm cast Angulation >15°, or complete displacement, certainly over the age of 10 years (Crawford) Some specialized surgical experience Basic equipment only
Closed reduction; K-wire fixation Instability after closed reduction Some specialized surgical experience Simple surgical and imaging resources
Open reduction; K-wire fixation Failure of closed reduction with residual angulation >15°, or complete displacement, certainly over the age of 10 years (Crawford) Some specialized surgical experience Simple surgical and imaging resources
External fixation Open fractures (Gustilo III) and/or polytrauma Some specialized surgical experience Simple surgical and imaging resources
Open reduction; Plate fixation Displaced and unstable fractures in an adolescent Some specialized surgical experience Simple surgical and imaging resources

23r-M/3.1 - Metaphyseal, simple complete, radius

Please select a treatment option:
Treatment Main indication Skill Equipment
Short or long arm cast Minimally displaced and stable fractures Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; Long arm cast Angulation of more than 15°, and children above 10 years of age Some specialized surgical experience Basic equipment only
Closed reduction; K-wire fixation Instability after closed reduction Some specialized surgical experience Simple surgical and imaging resources
Open reduction; K-wire fixation Failure of closed reduction with residual angulation >15°, or complete displacement, certainly over the age of 10 years (Crawford) Some specialized surgical experience Simple surgical and imaging resources
External fixation Open fractures (Gustilo III) and/or polytrauma Some specialized surgical experience Simple surgical and imaging resources
Open reduction; Plate fixation Displaced and unstable fracture in an adolescent Some specialized surgical experience Simple surgical and imaging resources

23u-M/3.1 - Metaphyseal, simple complete, ulna

Please select a treatment option:
Treatment Main indication Skill Equipment
Short or long arm cast Minimally displaced and stable fractures Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; Long arm cast Angulation of more than 15°, and children above 10 years of age Some specialized surgical experience Basic equipment only
Closed reduction; K-wire fixation Instability after closed reduction Some specialized surgical experience Simple surgical and imaging resources
Open reduction; K-wire fixation Failure of closed reduction Some specialized surgical experience Simple surgical and imaging resources

23-M/3.2 - Metaphyseal, multifragmentary complete, both bones

Please select a treatment option:
Treatment Main indication Skill Equipment
Closed reduction; Long arm cast Absence of appropriate surgical resources Some specialized surgical experience Basic equipment only
Closed reduction; K-wire fixation Only one intermediate fragment Some specialized surgical experience Basic equipment only
Open reduction; K-wire fixation Only one intermediate fragment and failure of closed reduction Some specialized surgical experience Simple surgical and imaging resources
External fixation Excessive comminution of either bone and/or open fractures Some specialized surgical experience Simple surgical and imaging resources
Open reduction; Plate fixation Displaced unstable fractures in adolescents Some specialized surgical experience Simple surgical and imaging resources

23r-M/3.2 - Metaphyseal, multifragmentary complete, radius

Please select a treatment option:
Treatment Main indication Skill Equipment
Long arm cast Undisplaced closed fracture Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; Long arm cast Displaced fractures in the absence of appropriate surgical resources Some specialized surgical experience Basic equipment only
Closed reduction; K-wire fixation Only one intermediate fragment Some specialized surgical experience Basic equipment only
Open reduction; K-wire fixation Only one intermediate fragment and failure of closed reduction Some specialized surgical experience Simple surgical and imaging resources
External fixation Excessive comminution and/or open fracture Some specialized surgical experience Simple surgical and imaging resources
Open reduction; Plate fixation Displaced unstable fracture in adolescents Some specialized surgical experience Simple surgical and imaging resources

23-E/1.1 - Simple epiphysiolysis, Salter-Harris I, both bones

Please select a treatment option:
Treatment Main indication Skill Equipment
Short or long arm cast Virtually undisplaced injury in compliant child Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; Short or long arm cast Total displacement of one of the epiphysis Some specialized surgical experience Basic equipment only

23r-E/1.1 - Simple epiphysiolysis, Salter-Harris I, radius

Please select a treatment option:
Treatment Main indication Skill Equipment
Short or long arm cast Virtually undisplaced injury in compliant child Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; Short or long arm cast Total displacement of the epiphysis Some specialized surgical experience Basic equipment only

23u-E/1.1 - Simple epiphysiolysis, Salter-Harris I, ulna

Please select a treatment option:
Treatment Main indication Skill Equipment
Short or long arm cast Virtually undisplaced injury in compliant child Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; Long arm cast Total displacement of the epiphysis Some specialized surgical experience Basic equipment only

23-E/2.1 - Simple epiphysiolysis with metaphyseal wedge, Salter-Harris II, both bones

Please select a treatment option:
Treatment Main indication Skill Equipment
Short or long arm cast Undisplaced fractures Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; Short or long arm cast Displaced injuries Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; K-wire fixation Displaced injuries Basic surgical experience, no specialized skills Basic equipment only
Open reduction; K-wire fixation Irreducible major displacement Some specialized surgical experience Simple surgical and imaging resources
External fixation Open fractures (Gustilo II or III) and/or polytrauma Some specialized surgical experience Simple surgical and imaging resources

23r-E/2.1 - Simple epiphysiolysis with metaphyseal wedge, Salter-Harris II, radius

Please select a treatment option:
Treatment Main indication Skill Equipment
Short or long arm cast Undisplaced fractures Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; Short or long arm cast Displaced injuries Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; K-wire fixation Displaced injuries Basic surgical experience, no specialized skills Basic equipment only
Open reduction; K-wire fixation Irreducible major displacement Some specialized surgical experience Simple surgical and imaging resources
External fixation Open fracture (Gustilo II or III) and/or polytrauma Some specialized surgical experience Simple surgical and imaging resources

23r-E/2.2 - Multifragmentary epiphysiolysis with metaphyseal wedge, Salter-Harris II, radius

Please select a treatment option:
Treatment Main indication Skill Equipment
Long arm cast Undisplaced closed fracture Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; Long arm cast Displaced fractures in the absence of appropriate surgical resources Basic surgical experience, no specialized skills Basic equipment only
External fixation Excessive comminution and/or open fracture Some specialized surgical experience Simple surgical and imaging resources

23u-E/2.1 - Simple epiphysiolysis with metaphyseal wedge, Salter-Harris II, ulna

Please select a treatment option:
Treatment Main indication Skill Equipment
Splint Undisplaced fracture Basic surgical experience, no specialized skills Basic equipment only
Short or long arm cast Undisplaced fractures Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; Long arm cast Displaced injuries Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; K-wire fixation Displaced injuries Basic surgical experience, no specialized skills Basic equipment only
Open reduction; K-wire fixation Irreducible major displacement Some specialized surgical experience Simple surgical and imaging resources

23-E/3.1 - Simple epiphyseal fractures, Salter-Harris III, both bones

Please select a treatment option:
Treatment Main indication Skill Equipment
Short or long arm cast Undisplaced joint surfaces Basic surgical experience, no specialized skills Simple surgical and imaging resources
Closed reduction; K-wire fixation Articular displacement Some specialized surgical experience Simple surgical and imaging resources
Open reduction; K-wire fixation Irreducible articular disruption Some specialized surgical experience Simple surgical and imaging resources

23r-E/3.1 - Simple epiphyseal fractures, Salter-Harris III, radius

Please select a treatment option:
Treatment Main indication Skill Equipment
Short or long arm cast Undisplaced joint surface Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; K-wire fixation Articular displacement Some specialized surgical experience Simple surgical and imaging resources
Open reduction; K-wire fixation Irreducible articular disruption Some specialized surgical experience Simple surgical and imaging resources

23r-E/4.1 - Simple epi-/metaphyseal fracture, Salter-Harris IV, radius

Please select a treatment option:
Treatment Main indication Skill Equipment
Short or long arm cast Totally undisplaced injury as demonstrated by additional imaging Basic surgical experience, no specialized skills Simple surgical and imaging resources
Closed reduction; K-wire fixation Articular and physeal displacement Some specialized surgical experience Simple surgical and imaging resources
Open reduction; K-wire fixation Irreducible articular and physeal displacement Some specialized surgical experience Simple surgical and imaging resources

23u-E/7 - Avulsion of the styloid, ulna

Please select a treatment option:
Treatment Main indication Skill Equipment
Splint Treatment of choice in the absence of carpal instability Basic surgical experience, no specialized skills Basic equipment only
Short or long arm cast Alternative to splint management in the absence of carpal instability Basic surgical experience, no specialized skills Basic equipment only
Open reduction; K-wire fixation Displaced ulnar styloid avulsion Some specialized surgical experience Basic equipment only
*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