Forearm fracture (peds): Difference between revisions
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==Background== | ==Background== | ||
*Mechanism: usually fall on outstretched hand (FOOSH) | |||
*Comprises 45% of all pediatric fractures | *Comprises 45% of all pediatric fractures | ||
*peak incidence 10-12 years of age in girls and 12-14 in boys | *peak incidence 10-12 years of age in girls and 12-14 in boys | ||
==Clinical Features== | ==Clinical Features== | ||
*Point tenderness, swelling, obvious deformity | |||
*Point tenderness, swelling, | |||
*Vast majority involve the distal third of the forearm | *Vast majority involve the distal third of the forearm | ||
| Line 28: | Line 28: | ||
===Workup=== | ===Workup=== | ||
*Radiographs: | *Radiographs: | ||
*AP and lateral of forearm | **AP and lateral of forearm | ||
* | **Also consider AP and lateral of elbow and/or hand | ||
===Evaluation=== | ===Evaluation=== | ||
*Clinically | *Clinically evaluate for: | ||
** | **Non-accidental trauma ([[Child abuse]]) | ||
**Puncture wounds | **Puncture wounds over/near fracture site (open fracture) | ||
**[[Compartment syndrome]] (rare) | **[[Compartment syndrome]] (rare) | ||
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**>10 degrees of angulation in children >8 yr | **>10 degrees of angulation in children >8 yr | ||
**>15-20 degrees of angulation in younger children | **>15-20 degrees of angulation in younger children | ||
*Otherwise, ortho f/u in 1 week | *Otherwise, discharge with ortho f/u in 1 week | ||
==See Also== | ==See Also== | ||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
Revision as of 08:09, 9 August 2015
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
Diagnosis
Workup
- Radiographs:
- AP and lateral of forearm
- Also consider AP and lateral of elbow and/or hand
Evaluation
- 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[1]
| Shaft / Both bone fx | Shaft / Both bone fx | Shaft / Both bone fx | 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 f/u in 1 week
See Also
External Links
References
- ↑ Orthobullets. Forearm Fractures - Pediatric