II. Mechanism
- Fall on Outstretched Hand (similar to other Forearm Fractures)
III. Types
- Forearm Buckle Fracture (or Torus Fracture)
- Incomplete compression Fracture resulting in cortical bulging without cortical disruption
- Greenstick or complete Radius Fracture
- Complete Radius-Ulna Fracture
- See Forearm Fracture
IV. Exam
- See Forearm Fracture
V. Signs
- See Forearm Fracture
- Distal radius (and/or ulna) metaphysis Fracture with tenderness and minimal to no deformity
VI. Imaging
- See Forearm Fracture
VII. Management: Partial or Non-displaced Fractures
- See Forearm Fracture
- Forearm Buckle Fracture (or Torus Fracture)
- Treated with short-arm splint, then Casting for total immobilization of 3 weeks
- Removable splint or nonrigid immobilization are reasonable alternatives
- Handoll (2018) Cochrane Database Syst Rev (12): CD012470 +PMID:30566764 [PubMed]
- Williams (2013) Pediatr Emerg Care 29(5):555-9 +PMID:23603644 [PubMed]
- Repeat Xray has been historically performed at 3 week follow-up visit
- However, some guidelines recommend follow-up imaging only for persistent symptoms or signs
- Riera-Alvarez (2019) J Pediatr Orthop B 28(6): 553-4 +PMID:32694434 [PubMed]
- Ling (2018) Radiol Res Pract +PMID:29686900 [PubMed]
- Treated with short-arm splint, then Casting for total immobilization of 3 weeks
- Greenstick Fractures or non-displaced Radius Fractures
- Short-arm splint, then Casting for total immobilization of 3 weeks
- Allowable deformity without reduction (closed or ORIF) in age <10 years old
- Angulation <20-30 degrees (sagittal alignment, lateral XRay)
- Displacement <50%
VIII. Management: Children with Displaced or Angulated Radius-Ulna Fractures
- See Forearm Fracture (includes indication for othopedic referral)
- Surgical intervention uncommon in children under age 10 years old
- Reduction Technique
- See Distal Radius Fracture
- Anesthesia
- Angulated Fractures
- Traction and Counter traction
- Greenstick Fractures
- Often require breakage of opposite cortex
- Prevents re-angulation in cast
- Displaced Fractures
- Traction and Counter traction
- Slight bayonet apposition is acceptable
- Alignment must be satisfactory
- Immobilization
- Start with sugar tong splint, then Long Arm Cast for 7-8 weeks
- Positioning
Images: Related links to external sites (from Bing)
Related Studies
Concepts | Injury or Poisoning (T037) |
SnomedCT | 390010008, 390986009 |
Spanish | fractura incompleta de radio con expansión localizada de la corteza, fractura incompleta de radio con abultamiento cortical (torus) (trastorno), fractura incompleta de radio con expansión localizada de la corteza (trastorno), fractura incompleta de radio con abultamiento cortical (torus) |
English | fracture of radius torus, Torus fracture of radius (diagnosis), Torus fracture of radius, Torus fracture of radius (disorder) |
Ontology: Torus fracture of ulna (alone) (C2712372)
Concepts | Injury or Poisoning (T037) |
ICD9 | 813.46 |
English | Torus fx ulna-closed, Torus fracture of ulna (alone) |
Ontology: Torus fracture of radius and ulna (C2712373)
Concepts | Injury or Poisoning (T037) |
ICD9 | 813.47 |
English | Torus fracture of radius and ulna, Torus fx radius/ulna-clo |
Ontology: greenstick fracture of ulnar shaft (C2844798)
Concepts | Injury or Poisoning (T037) |
ICD10 | S52.21 |
English | Greenstick fracture of shaft of ulna, greenstick fracture of ulnar shaft, fracture of ulna shaft greenstick, greenstick fracture of ulnar shaft (diagnosis) |
Ontology: greenstick fracture of radial shaft (C2845544)
Concepts | Injury or Poisoning (T037) |
ICD10 | S52.31 |
English | Greenstick fracture of shaft of radius, fracture of radius shaft greenstick, greenstick fracture of radial shaft, greenstick fracture of radial shaft (diagnosis) |