Challenges in Pediatric Trauma: What We All Need to Know About Diaphyseal Forearm Fractures

Diaphyseal fractures of the radius and ulna are common injuries in children and often result from a fall on an outstretched hand. Fractures are classified by completeness, angular and rotational deformity, and displacement. The goal of management is to correct the deformity to the anatomic position or within acceptable alignment parameters as defined in the literature. This is primarily achieved by closed reduction and immobilization. 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 healing is evident. Follow-up radiographs should be obtained weekly during the first 3 weeks after reduction to assess loss of reduction. Generally, postreduction malalignment greater than 20° is unacceptable, but these parameters vary based on age, fracture pattern, and the location and plane of angulation. 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. Successful outcomes are seen in most forearm fractures in children, based on bone healing and restoration of functional forearm range of motion.