Forearm Fractures 09/18/2013. Mechanism: Usually a fall on an outstretched arm. Incidence. Mechansim

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1 September 20, 2013 Amanda Taylor PA-C Children s Orthopaedics of Louisville Forearm Fractures Incidence 40-50% of all pediatric fractures Mechansim Wide range of mechanism Mechanism: Usually a fall on an outstretched arm 1

2 Fracture Location Distal 75% Middle 18% Proximal 7% Presenting Symptoms Evaluation Pain, swelling, bruising, deformity Physical Exam Evaluate joint ABOVE AND BELOW Deformity, swelling, inability to rotate forearm, point tenderness AIN and PIN Radiographs Buckle/torus fractures Distal Radius Compression failure with no disruption of the cortex Greenstick fractures Cortex is disrupted on the tension side and intact on the compression side. Complete Disruption of both cortices Physeal Involving the growth plate 2

3 Buckle/torus fracture Very stable Treatment Distal Radius At ED/ICC wrist brace or short arm splint Office Short Arm Cast Duration 3-4 weeks depending on age. Greenstick fracture May be stable or unstable Treatment ED/ICC may or may not need a reduction If not reduced place in a sugar tong or long arm splint Office Munster or long arm cast Duration 4-5 weeks Distal Radius 3

4 Complete Distal Radius Displaced at time of injury Will need a reduction with a long arm cast Nondisplaced at time of injury At ED/ICC place in long arm splint At office place in long arm cast and follow Total treatment time 4-6 weeks Same fracture after one week in cast 4

5 Physeal Fractures Classification Salter Harris Limit attempts at Closed Reduction Educate parents Risk of growth arrest Follow up 6 months Salter Harris Classification History: patient fell off some playground equipment Exam: point tender at distal radius with minimal swelling in the wrist Is there a fracture? Question? 5

6 Salter Harris II Fracture After closed reduction one week After 4 weeks in the cast 6

7 After 2 more weeks in a cast Operative treatment for distal radius Closed Reduction Closed Reduction with percutaneous pinning 7

8 Plastic deformation Forearm Fractures Left untreated may decrease rotation Very difficult to correct Ulna Most important to restore length Reduce first Radius Restore bowing for rotation Isolated ulna fracture 3 year old male What is the next question to ask yourself? Monteggia Fracture 8

9 Monteggia Fracture Ulna fracture with radio-capitellar dislocation Closed reduction Long arm cast Casting with arm in supination will help keep radial head located If radial head remains unstable and does not stay reduced, may need to treat with fixation of the ulna Both bone forearm fractures Generally treated with closed reduction After closed reduction they are put in a long arm cast If concerned about swelling, mono-valve or bi-valve Needs close follow-up to watch for failure Both bone forearm fractures Nonoperative Long arm cast for 4 weeks (checking alignment weekly as needed) Then transition to munster or short arm cast for an additional 2-3 weeks Operative Closed reduction or repeat closed reduction Intramedullary fixation 9

10 Both bone forearm fractures Risk of refracture 6 months Educate about increased risk with activities such as contact sports and high impact activites (trampolines, bounces, tumbling) Acceptable alignment Acceptable angulation is controversial in the ortho community Acceptable angulation depends on: Age of patient Location of fracture Closer to physis = greater remodeling potential Type of deformity Angulation, bayoneting, and rotation 10

11 11

12 2 years later after returning to our office for knee pain 12

13 Thanks 13

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