Open and Closed Management of Pediatric Forearm Fractures

Abstract

Fractures of the forearm are common injuries in the pediatric population. The mechanism of their occurrence is usually indirect trauma, such as a fall onto an outstretched hand during play or athletic activity. The classification of forearm fractures is based on the location in the affected bone(s) and the pattern of injury, in addition to a description of the magnitude of fracture angulation, displacement, shortening, and rotation. The vast majority of pediatric forearm fractures may be treated with closed reduction and immobilization, with serial radiographs used to monitor the maintenance of adequate fracture alignment during bone healing. In general, the younger the patient and more distal a fracture, the greater is the potential for fracture remodeling, although the observed imperfect correlation between the radiographic appearance and functional outcome of forearm fractures in pediatric patients makes the choice of their treatment a challenge in any particular case. Fractures for which an acceptable alignment cannot be obtained or maintained, open fractures, and those associated with significant soft-tissue or neurovascular compromise may be treated surgically. Viable options for the surgical treatment of pediatric forearm fractures include closed or open reduction and intramedullary fixation of one or both bones of the forearm; open reduction and internal fixation using a plate and screw construct; and hybrid techniques. Complications of the treatment of pediatric forearm fractures include refracture, loss of motion, cosmetic deformity, delayed union, nonunion, malunion, infection, and compartment syndrome.

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