1 Introduction topenlarge
This is a rare injury. In younger children bear in mind the possibility of nonaccidental injury.
If there is diagnostic doubt, screening by image intensification can be useful.
Significant displacement is rare.
2 Reduction topenlarge
Indirect reduction by forearm rotation
Reduction maneuver is by forearm rotation and direct pressure over the distal ulna.
Anteriorly displaced fractures are reduced by forearm pronation.
Posteriorly displaced fractures are reduced by forearm supination.
In the unlikely event of failure of reduction, K-wire stabilization may be required.
Direct reduction using K-wire
For irreducible fractures, a K-wire can be inserted into the fracture site and used as a lever to facilitate reduction of the ulna.
Note: This technique applies pressure to the already compromised growth plate and should be used only exceptionally and with great care.
3 Long arm cast topenlarge
Once the fracture displacement has been reduced, the arm is splinted in a long arm cast.
The purpose of the cast is to maintain the reduction by preventing forearm rotation.
The position of the forearm depends on the direction of the original displacement, with the forearm pronated for a anteriorly displaced fracture, and supinated for a posteriorly displaced fracture.
The long arm cast is applied according to standard procedure:
Splitting of the cast
If a complete cast is applied in the acute phase after injury, it is safer to split the cast down to skin over its full length.