Proximal Third Both Bone Forearm Fractures

Abstract

Both bone forearm fractures (BBFF) are among the most common fractures seen in the pediatric population, accounting for 5–10% of all pediatric fractures. Anatomically, these injuries are subdivided into distal, middle, and proximal thirds, with distal injuries being most common. The bony architecture of the radius changes from proximal to distal, going from cylindrical, transitioning through triangular to elliptical as it approaches the distal portion of the forearm. This, in part, is why distal injuries are more common. Additionally, the muscular envelope in the proximal forearm helps prevent fractures in this region. Tendinous attachments of the proximal forearm also lead to a reproducible displacement pattern, with the proximal fragment being flexed and externally rotated due to the unopposed pull of the supinator and biceps muscles. The majority of BBFF can be treated with closed reduction and casting, with the forearm placed in a neutral to supinated position for proximal third fractures. However, the remodeling potential following proximal third injuries is significantly decreased given its distance from the more active, distal radius physis. Thus, patients with proximal BBFF have a more guarded prognosis and more stringent reduction parameters. If adequate closed reduction cannot be maintained, operative stabilization is required to prevent residual functional deficits. Commonly used surgical options include intramedullary nailing and open reduction internal fixation (ORIF).