1 Introduction topenlarge
These fractures are usually posteriorly angulated (apex anterior) and can generally be reduced closed, ideally under general anesthesia. Impediments to reduction include interposed periosteum and pronator quadratus.
Anteriorly angulated (apex posterior) fractures are less common and are also generally reduced closed. Impediments to reduction include the extensor tendons.
Most of these fractures are stable after reduction and do not require fixation, particularly in younger children. In children approaching skeletal maturity instability after reduction becomes more likely.
2 Reduction topenlarge
Indirect reduction of completely posteriorly displaced fractures
In these rare multifragmentary fractures, the standard closed reduction maneuvers are unlikely to result in stability.
Reduction relies on longitudinal distraction with direct manual pressure over the displaced distal fragment.
Failure to achieve a stable reduction is a strong indication for internal fixation using K-wires and accepting some residual displacement, in anticipation of subsequent fracture modelling.
An assistant is required to maintain the reduction throughout the cast application. The presence of the assistant will, however, not be shown in all of the following illustrations.
3 Long arm cast topenlarge
A long arm cast should always be used where it is necessary to control forearm rotation in order to prevent fracture displacement. In very young and in noncompliant children, a long arm cast is preferable even if a short cast would otherwise be appropriate
The long arm cast is applied according to standard procedure:
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.