Executive Editor: James Hunter General Editor: Fergal Monsell

Authors: Andrew Howard, Peter Schmittenbecher, Theddy Slongo

Pediatric forearm shaft

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Glossary

22-D - Both bones, combination of radial and ulnar fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Cast or splint fixation without reduction Stable fracture including bowing, minimally deformed/displaced/angulated greenstick and complete fracture Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; cast fixation +/- wedging Fracture manipulation leading to stable configuration (minimally deformed/displaced and angulated) possible Some specialized surgical experience Simple surgical and imaging resources
External fixation Refracture; distal meta-diaphyseal fracture; ESIN not available; soft-tissue injury Highly experienced and skilled surgeon Simple surgical and imaging resources
ESIN Any unstable fracture Some specialized surgical experience Simple surgical and imaging resources
Open reduction; plate fixation Unstable fracture in adolescents and young adults; distal meta-diaphyseal fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources

22u-D/6 - Monteggia lesion

Please select a treatment option:
Treatment Main indication Skill Equipment
Closed reduction; cast fixation Fracture manipulation leading to stable ulnar fracture and reduced and stable radiocapitellar joint possible Some specialized surgical experience Basic equipment only
External fixation Insufficient radial head stability; multifragmentary and open fracture; ESIN not available Highly experienced and skilled surgeon Simple surgical and imaging resources
ESIN Treatment of choice Some specialized surgical experience Simple surgical and imaging resources
Open reduction; plate fixation Insufficient stability to hold radial head reduced; unstable injury in adolescents and young adults Highly experienced and skilled surgeon Full specialized surgical and imaging resources

22u-D, 21r-E/M - Monteggia equivalent

Please select a treatment option:
Treatment Main indication Skill Equipment
Cast fixation without reduction Stable, minimally deformed/displaced ulnar fracture, undisplaced radial neck fracture Basic surgical experience, no specialized skills Basic equipment only
External fixation Multifragmentary or open ulnar fracture; severe soft-tissue injury Highly experienced and skilled surgeon Simple surgical and imaging resources
ESIN Any unstable fracture Some specialized surgical experience Simple surgical and imaging resources
Open reduction; plate fixation (ulna) Unstable injury in adolescents and young adults Highly experienced and skilled surgeon Full specialized surgical and imaging resources

22r-D/1.1 - Radius, bowing

Please select a treatment option:
Treatment Main indication Skill Equipment
Cast or splint fixation without reduction Normal or slightly limited initial function; preliminary treatment Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; cast or splint fixation Primary treatment if forearm function restricted Some specialized surgical experience Basic equipment only
ESIN Limited function; cosmetic correction Some specialized surgical experience Simple surgical and imaging resources

22r-D/2.1 - Radius, greenstick

Please select a treatment option:
Treatment Main indication Skill Equipment
Cast or splint fixation without reduction Minimally angulated; preliminary treatment Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; cast or splint fixation Primary treatment if forearm function restricted Some specialized surgical experience Basic equipment only
ESIN Limited function; cosmetic correction Some specialized surgical experience Simple surgical and imaging resources

22r-D/4.1 - Radius, complete transverse, simple

Please select a treatment option:
Treatment Main indication Skill Equipment
Cast or splint fixation without reduction Stable fracture, minimally displaced and angulated Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; cast or splint fixation Primary treatment for displaced fractures at every age, often definitive treatment for patients younger than 10 years Some specialized surgical experience Basic equipment only
External fixation Refracture; distal meta-diaphyseal fracture; ESIN not available Highly experienced and skilled surgeon Simple surgical and imaging resources
ESIN Any unstable fracture Some specialized surgical experience Simple surgical and imaging resources
Open reduction; plate fixation Unstable fracture in adolescents and young adults; distal meta-diaphyseal fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources

22r-D/5 - Radius, complete oblique or spiral

Please select a treatment option:
Treatment Main indication Skill Equipment
Cast or splint fixation without reduction Minimally displaced and angulated fracture Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; cast or splint fixation Closed manipulation of simple fractures producing stable reduction (minimally displaced and angulated) possible Some specialized surgical experience Basic equipment only
External fixation ESIN not available or providing insufficient stability; distal meta-diaphyseal fracture Highly experienced and skilled surgeon Simple surgical and imaging resources
ESIN Any unstable fracture Some specialized surgical experience Simple surgical and imaging resources
Open reduction; plate and screw fixation Unstable simple fracture in adolescents and young adults; ESIN not available or providing insufficient stability; distal meta-diaphyseal fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; bridge plating Multifragmentary fracture in adolescents and young adults; ESIN not available or providing insufficient stability; distal meta-diaphyseal fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources

22u-D/1.1 - Ulna, bowing

Please select a treatment option:
Treatment Main indication Skill Equipment
Cast or splint fixation without reduction Normal or slightly limited initial function; preliminary treatment Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; cast or splint fixation Primary treatment if forearm function restricted Some specialized surgical experience Basic equipment only
ESIN Limited function; cosmetic correction Some specialized surgical experience Simple surgical and imaging resources

22u-D/2.1 - Ulna, greenstick

Please select a treatment option:
Treatment Main indication Skill Equipment
Cast or splint fixation without reduction Minimally angulated; preliminary treatment Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; cast or splint fixation Primary treatment if forearm function restricted Some specialized surgical experience Basic equipment only
ESIN Limited function; cosmetic correction Some specialized surgical experience Simple surgical and imaging resources

22u-D/4.1 - Ulna, complete transverse, simple

Please select a treatment option:
Treatment Main indication Skill Equipment
Cast or splint fixation without reduction Stable fracture, minimally displaced and angulated Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; cast or splint fixation Primary treatment for displaced fractures at every age, often definitive treatment for patients younger than 10 years Some specialized surgical experience Basic equipment only
External fixation Refracture; distal meta-diaphyseal fracture; ESIN not available; open fracture Highly experienced and skilled surgeon Simple surgical and imaging resources
ESIN Any unstable fracture Some specialized surgical experience Simple surgical and imaging resources
Open reduction; plate fixation Unstable fracture in adolescents and young adults; distal meta-diaphyseal fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources

22u-D/4.2 - Ulna, complete transverse, multifragmentary

Please select a treatment option:
Treatment Main indication Skill Equipment
Cast or splint fixation without reduction Minimally displaced and angulated fracture Basic surgical experience, no specialized skills Basic equipment only
External fixation ESIN not available or providing insufficient stability; distal meta-diaphyseal fracture Highly experienced and skilled surgeon Simple surgical and imaging resources
ESIN Any unstable fracture Some specialized surgical experience Simple surgical and imaging resources
Open reduction; bridge plating Unstable fracture in adolescents and young adults; ESIN not available or providing insufficient stability Highly experienced and skilled surgeon Full specialized surgical and imaging resources

22u-D/5 - Ulna, complete oblique or spiral

Please select a treatment option:
Treatment Main indication Skill Equipment
Cast or splint fixation without reduction Minimally displaced and angulated fractures Basic surgical experience, no specialized skills Basic equipment only
Closed reduction; cast or splint fixation Closed manipulation of simple fractures producing stable reduction (minimally displaced and angulated) possible Some specialized surgical experience Basic equipment only
External fixation ESIN not available or providing insufficient stability; distal meta-diaphyseal fracture Highly experienced and skilled surgeon Simple surgical and imaging resources
ESIN Any unstable fracture Some specialized surgical experience Simple surgical and imaging resources
Open reduction; plate and screw fixation Unstable simple fracture in adolescents and young adults; ESIN not available or providing insufficient stability; distal meta-diaphyseal fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Open reduction; bridge plating Multifragmentary fracture in adolescents and young adults; ESIN not available or providing insufficient stability; distal meta-diaphyseal fracture Highly experienced and skilled surgeon Full specialized surgical and imaging resources
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2018-11-28