Forearm fracture (peds)

Background

• Comprises 45% of all pediatric fractures
• peak incidence 10-12 years of age in girls and 12-14 in boys

Clinical Features

• Mechanism: usually fall on outstretched hand
• Point tenderness, swelling, and 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

Diagnosis

Evaluation

• Clinically rule out:
  • rule out child abuse
  • Puncture wounds indicating open fracture
  • Compartment syndrome (rare)

Management

• 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, ortho f/u in 1 week