Multiple Unilateral Upper Limb Fractures in the Pediatric Setting - A Case Report

Area of Science:

• Pediatric Orthopedics
• Pediatric Trauma Surgery
• Pediatric Radiology

Background:

• Lateral condyle fractures and both bone forearm fractures are common pediatric elbow injuries.
• Forearm fractures in children necessitate thorough elbow examination due to a 5% association with supracondylar fractures.
• Concurrent upper limb fractures require comprehensive radiographic assessment of joints above and below the injury site.

Observation:

• A 5-year-old boy sustained multiple left upper limb fractures after a fall: minimally displaced lateral condyle fracture, midshaft ulna fracture, and displaced distal radius and ulna fracture.
• The patient remained neurovascularly intact; metabolic bone disease and non-accidental injury were excluded.
• Initial management included an above-elbow cast, with CT imaging for detailed assessment and trauma center consultation.

Findings:

• Conservative management was chosen for the minimally displaced lateral condyle fracture.
• Open reduction and internal fixation with a plate were used for the displaced distal radius fracture.
• The ulna shaft fracture was managed with manipulation and casting, achieving full radiological union and range of motion within 12 weeks.

Implications:

• This case underscores the necessity of secondary surveys in pediatric trauma to detect associated injuries.
• Minimally displaced lateral condyle fractures can be effectively managed non-operatively.
• Single-bone fixation, particularly plate and screw fixation for metaphyseal/diaphyseal junction fractures, offers favorable outcomes in pediatric both bone forearm fractures.