Forearm fracture (peds): Difference between revisions
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==Management== | ==Management== | ||
{{General Fracture Management}} | |||
===Immobilization=== | |||
*Greenstick and complete fracture | *Greenstick and complete fracture | ||
**[[Sugar tong splint]] is preferred over simple [[volar splint]] | **[[Sugar tong splint]] is preferred over simple [[volar splint]] | ||
==Disposition== | ==Disposition== | ||
Revision as of 04:43, 18 September 2019
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%)
- 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
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
General Fracture Management
- Acute pain management
- Open fractures require immediate IV antibiotics and urgent surgical washout
- Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
- Consider risk for compartment syndrome
Immobilization
- Greenstick and complete fracture
- Sugar tong splint is preferred over simple volar splint
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