Challenges in Pediatric Trauma: Diaphyseal Forearm Fractures. |
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Challenges in Pediatric Trauma: Diaphyseal Forearm Fractures.

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A recent article published in Instructional Course Lectures discussed that diaphyseal fractures of the radius and ulna are common in children and often result from a fall on an outstretched hand. Such fractures are classified by the completeness, angular and rotational deformity and displacement. The authors reported that the goal of management in these cases is to correct the deformity, to the anatomic position or within acceptable alignment parameters, as defined in literature. This is primarily achieved by closed reduction and immobilization. This article informed that greenstick fractures are reduced by rotation of the palm toward the apex of the deformity. Complete fractures are reduced with sustained traction and manipulation. All fractures are immobilized in a cast, applied with the proper molding technique to ensure adequate stabilization, and maintained until the healing is evident. Subsequently, follow-up radiographs should be obtained weekly during the first 3 weeks after reduction to assess loss of reduction. Generally, post-reduction malalignment greater than 20° is unacceptable. However, these parameters vary based on age, fracture pattern, and the location and plane of angulation. It was further stated that surgical intervention, with intramedullary nailing or plate fixation, is indicated for open fractures, for those with substantial soft-tissue injury, and when acceptable alignment cannot be achieved or maintained. Moreover, successful outcomes are seen in most forearm fractures in children, based on bone healing and restoration of functional forearm range of motion.

Source: Instructional Course Lectures. 2019;68:383-394.

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