Executive Editor: James Hunter General Editor: Fergal Monsell

Authors: Andrew Howard, Peter Schmittenbecher, Theddy Slongo

Pediatric forearm shaft 22u-D, 21r-E/M

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1 General considerations top

Plating of the ulna and ESIN of the radial head enlarge

Plating is the standard technique for treating forearm fractures in adults and is therefore best considered for skeletally mature or nearly mature children.

Children with open physes have thick active periosteum favoring stability and rapid healing with ESIN techniques. Where such techniques are unavailable plating may be used in younger children.

2 Principles top

Order of reduction and fixation enlarge

Order of reduction and fixation

The ulna is treated first.

The radial neck fracture may spontaneously reduce after anatomical reduction and fixation of the ulna.

The radial neck fracture should be fixed with an intramedullary nail to prevent redisplacement and to allow early joint mobilization.

Combination with other treatment options

Plating the ulna may be combined with ESIN of the proximal radial fracture.

This allows for stable anatomical restoration of the forearm axis and early motion.

Direct approach to the ulna enlarge

Choice of approach

The ulna is exposed by the direct approach between the flexor and extensor muscle compartments.

Lateral approach to the proximal radius enlarge

If there is residual displacement of the radial neck fracture after optimization of the ulnar correction, a closed reduction using ESIN or an open reduction should be performed.

Open reduction may also be necessary if an image intensifier is not available or if soft-tissue structures are trapped between the fragments.

A lateral approach to the proximal radius may be used to visualize the radial neck fracture.

3 Reduction and fixation of the ulna top

Reduction and fixation of the ulna enlarge

The steps for ulnar fracture fixation are described in the relevant plating procedure for each fracture type:

4 Reduction and fixation of radial head/neck top

Reduction and fixation of radial head/neck enlarge

The steps required for proximal radial fracture fixation are described in the ESIN procedures for each fracture type:

5 Final assessment top

Radiological confirmation enlarge

Check the completed osteosynthesis with image intensification. These images should be retained for documentation or alternatively an x-ray should be obtained before discharge.

Make sure that the plate is at the correct location, the screws and the nail are of appropriate length and the desired reduction has been achieved.

Check the forearm rotation. enlarge

Stabilize the elbow at the epicondyles and check the forearm rotation.

v1.0 2018-11-28