General Editor: Chris Colton

Authors: Fergal Monsell, Dalia Sepulveda

Pediatric distal forearm 23u-E/7

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1 Introduction top


Note: Be aware of nonaccidental injury in infants.

Careful scrutiny of the x-rays is important to identify the presence or absence of a metaphyseal component, as this may be the only radiologically visible sign of a corner/bucket handle fracture.

2 K-wire fixation top


Skin incision

A small skin incision is made directly over the ulnar styloid.

The incision is deepened to the bone using a blunt artery forceps and a protective sleeve is inserted.

Care should be taken to avoid damage to the dorsal sensory branch of the ulnar nerve.


K-wire insertion

A single 1.6 mm smooth K-wire is inserted into the detached styloid fragment and used as a joystick to achieve reduction under direct vision.

The wire should be inserted using a T-handle.

Once reduction is satisfactory, the K-wire is advanced until it just engages the radial cortex of the distal ulnar metaphysis.

Ideally, the K-wire is inserted under image intensifier control to check the trajectory of the wire and to ensure engagement of the far cortex without penetration into the soft tissues.


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

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

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

3 Short arm cast top


General considerations

The purpose of the cast is protective and for pain relief, as stability is provided by the K-wire.

The short arm cast is applied according to standard procedure:

Note: In young, small, or noncompliant patients, it is safer to apply a long arm cast. 


Splitting of 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.

4 Long arm cast top


In the event that a long arm cast is necessary (see above) it is applied and split according to standard procedure.

v1.0 2016-12-01