Diaphyseal fractures of the ulna and radius are frequent injuries in the pediatric population. These fractures are typically the result of low-energy falls onto an outstretched hand. Nevertheless, a careful assessment of the patient is imperative, with evaluation of the skin and soft tissues for lacerations, compartment swelling, as well as a complete neurovascular examination. The majority of forearm fractures are closed injuries without associated nerve injuries or vascular compromise. These fractures are most often best treated with primary closed reduction and cast immobilization.
Forearm fractures that necessitate surgical fixation include irreducible or unstable fractures that have failed an attempt at closed reduction, open fractures, and fractures associated with severe soft tissue trauma, “floating elbow” injuries, vascular injury, or compartment syndrome. Flexible intramedullary nail fixation is the treatment of choice for most children and skeletally immature adolescents. Surgical treatment is generally associated with an increased number of complications, especially in children older than 10 years of age. Compartment syndrome, infections, nerve injuries, and extensor tendon injuries are the most common complications associated with surgical treatment. This chapter will focus on closed reduction and casting, surgical treatments, and avoidance of complications.
KeywordsCompartment Syndrome Closed Reduction Forearm Fracture Forearm Rotation Radial Styloid
- Crawford AH. Orthopedic injury in children. In: Callaham ML, editor. Current practice of emergency medicine. 2nd ed. Philadelphia: BC Decker; 1991. p. 1232–3.Google Scholar
- Doyle JR, Botte MJ. Surgical anatomy of the hand & upper extremity. Philadelphia: Lippincott Williams & Wilkins, 2003:34–40.Google Scholar
- Milch H. Roentenographic diagnosis of torsional deformities in tubular bones. Surgery 1944;15:440–450.Google Scholar
- Ogden JA. Skeletal injury in the child. Philadelphia: Lea & Febiger, 1982:56–57.Google Scholar
- Rang M. Children’s fractures. Philadelphia: JB Lippincott; 1983.Google Scholar
- Reinhardt KR, Feldman DS, Green DW, Sala DA, Widmann RF, Scher DM. Comparison of intramedullary nailing to plating for both-bone forearm fractures in older children. J Pediatr Orthop. 2008;28(4):404–9.Google Scholar
- Sage FP. Medullary fixation of fractures of the forearm: a study of the medullary canal of the radius and a report of fifty fractures of the radius treated with a prebent triangular nail. J Bone Joint Surg [Am] 1959;41:1489–1516.Google Scholar
- Sanders WE, Heckman JD. Traumatic plastic deformation of the radius and ulna. Clin Orthop Relat Res. 1984b;188:65.Google Scholar
- Silberstein MJ, Brodeur AE, Graviss ER. Some vagaries of the radial head and neck. J Bone Joint Surg [Am] 1982;64:1153–1157.Google Scholar
- Silberstein MJ, Brodeur AE, Graviss ER, Luisiri A. Some vagaries of the olecranon. J Bone Joint Surg [Am] 1981;63:722–725.Google Scholar
- Standring S, Borley NR, Collins P, Crossman AR, Gatzoulis MA, Healy JC, Johnson D, Mahadevan V, Newell RLM, Wigley CB. “Forearm”, Gray’s Anatomy, Fortieth Edition. Churchill Livingstone Elsevier. 2008;839–856.Google Scholar