Forearm fracture (peds)

Background

• Mechanism: usually fall on outstretched hand (FOOSH)
• Comprises 45% of all pediatric fractures
• peak incidence 10-12 years of age in girls and 12-14 in boys

Clinical Features

• Point tenderness, swelling, obvious deformity
• Vast majority involve the distal third of the forearm

Differential Diagnosis

Pediatric forearm fracture types

• Diaphysis (20%)
  • Both bone fracture
  • Greenstick fracture
• Metaphysis (62%)
  • Distal radius fracture (Colle's)
  • Torus fracture
• Distal physis
  • Salter-Harris I
  • Salter-Harris II
  • Salter-Harris III
  • Salter-Harris IV
• Fracture with dislocation
  • Monteggia’s fracture
  • Galeazzi fracture

Evaluation

Workup

• Radiographs:
  • AP and lateral of forearm
  • Also consider AP and lateral of elbow and/or hand

Diagnosis

• Clinically evaluate for:
  • Non-accidental trauma (Child abuse)
  • Puncture wounds over/near fracture site (open fracture)
  • Compartment syndrome (rare)

Management

• Greenstick and complete fracture
  • Sugar tong splint is preferred over simple volar splint

Specialty Management

	Shaft / Both bone fracture	Shaft / Both bone fracture	Shaft / Both bone fracture	Distal radius/ulna
Age	Acceptable Bayoneting	Shaft Acceptable Angulations	Malrotation	Dorsal Angulation
< 9 yrs	< 1 cm	15°	45°	30 degrees
> 9 yrs.	< 1 cm	10°	30°	20 degrees

Disposition

• Consult ortho if:
  • Rotational deformity
  • >10 degrees of angulation in children >8 yr
  • >15-20 degrees of angulation in younger children
• Otherwise, discharge with ortho follow up in 1 week

References

Authors

Ross Donaldson, Jordan Swartz, Michael Holtz, Daniel Ostermayer, Neil Young