Distal forearm fractures in children: Initial management
- Paula Schweich, MD
Paula Schweich, MD
- Clinical Professor of Pediatrics
- University of Washington School of Medicine
- Section Editor
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Childhood forearm fractures are very common and typically occur after a fall on an outstretched hand. Early assessment should focus on identifying an open fracture, neurovascular compromise, and/or associated injuries. The correct radiographic diagnosis at the time of injury is essential to proper care.
Initial care of nondisplaced fractures consists of pain control, splinting, and measures aimed at reducing swelling. Nondisplaced distal forearm fractures other than complete fractures of the distal radius and ulna can then be referred for scheduled evaluation and further management by an orthopedist with pediatric expertise.
Closed reduction is adequate treatment for many displaced forearm fractures and is often accomplished under sedation in the emergency department. Prompt orthopedic consultation is indicated for an important subset of distal forearm fractures to ensure the best outcome. Early orthopedic follow-up for potentially unstable fractures is essential to avoid long-term complications.
The initial management of distal forearm fractures in children will be reviewed here. The diagnosis, assessment, fracture reduction, and casting of distal forearm fractures in children and the care of pediatric proximal or midshaft forearm fractures are discussed separately:
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- INITIAL TREATMENT
- Absent pulse
- Open fracture
- Analgesia and immobilization
- INDICATIONS FOR ORTHOPEDIC CONSULTATION OR REFERRAL
- DEFINITIVE CARE
- Physeal fracture
- - Nondisplaced Salter I or II fractures
- - Displaced Salter I or II fractures
- - Salter III, IV, and V fractures
- Torus (buckle) fracture
- - Follow-up
- Greenstick fracture
- - Nondisplaced
- - Mild displacement
- - Moderate to severe displacement
- Complete fracture
- Ulnar styloid fracture
- Galeazzi fracture
- FRACTURE REDUCTION AND CASTING
- DISCHARGE AND FOLLOW-UP
- Home pain management
- Immobilization and return to activity
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS