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