1 Introduction topenlarge
These fractures are often caused by a direct blow. The direction of displacement depends on the direction of the blow.
In younger children bear in mind the possibility of nonaccidental injury.
2 Reduction topenlarge
Direct reduction using K-wire
In the presence of an intact radius, and complete displacement, it is not possible to achieve closed reduction. Direct reduction using a percutaneous K-wire (inserted through a stab incision) is required.
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.