General Editor: Chris Colton

Authors: Fergal Monsell, Dalia Sepulveda

Pediatric distal forearm 23u-E/2.1

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Glossary

1 Introduction top

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With this type of fracture it is rare for there to be major displacement.

2 Reduction top

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If closed reduction is impossible, this may be due to soft tissue interposition, possibly including the ulnar nerve, or an adjacent tendon.

Open reduction can be performed via a direct approach to the subcutaneous surface of the ulna.


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Open reduction

For irreducible fractures, initially, any interposed soft tissue structures are identified and cleared.


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Reduction is performed under direct vision.

This may require using a K-wire used as a lever, to facilitate reduction of the ulna.

3 K-wire fixation top

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The fracture is stabilized using a single smooth 1.6 mm K-wire through the ulnar styloid, across the physis, engaging the lateral cortex of the ulnar diaphysis.

Continued care should be taken to avoid the dorsal sensory branch of the ulnar nerve during insertion of the K-wire.

The wire should be inserted with an oscillating drill, cooled with saline solution to prevent thermal injury, or by hand using a T-handle.


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Ideally, wire insertion is done using image intensification control, in order to check the trajectory of the wire and to ensure engagement of the far diaphyseal cortex without penetration of soft tissues.


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The K-wire is left protruding through the skin, bent and cut. The skin is protected with sterile padding prior to application of a cast.

The illustration demonstrates the use of a small section of plastic tubing over the cut end of the protruding wire. This adds further protection for the skin.

Note: Excessive pressure between dressing and skin should be avoided to prevent skin necrosis.

4 Long arm cast top

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General considerations

Once the fracture displacement has been reduced and fixed with a K-wire, the arm is splinted in a reduced position with a long arm cast to control forearm rotation.

The purpose of the cast is to maintain reduction by preventing forearm rotation and protect the fixation.

The long arm cast is applied according to standard procedure:


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Splitting of the cast

If a complete cast is applied in the acute phase after injury, it should be split over the full length of the cast. The split of the cast must be full thickness and expose the underlying skin.

v1.0 2016-12-01