Midshaft forearm fractures in children
- 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)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Midshaft fractures of the forearm will be addressed here. The diagnosis and management of distal forearm fractures in children and other upper extremity fractures are discussed separately. (See "Distal forearm fractures in children: Initial management" and "Evaluation and management of supracondylar fractures in children" and "Midshaft humeral fractures in children".)
Forearm fractures are the most common fractures in children, representing 40 to 50 percent of all childhood fractures [1,2]. In one large series, forearm shaft fractures of the radius ranked as the third most common fracture after distal radial fractures and supracondylar humeral fractures . In addition, midshaft forearm fractures are the most common sites for refracture in children and among the most common sites of pediatric open fractures .
Forearm fractures have been associated with falls from playground equipment (eg, monkey bars) and from backyard trampolines [5,6]. However, any fall with adequate force may result in fracture.
The bones, muscles, ligaments, and tendons all work together in stabilizing the forearm. An interosseous membrane connects the radius and ulna, and the radius rotates around the ulna during supination and pronation of the forearm (figure 1 and figure 2) [1,7-10]. The two areas where the radius and ulna meet, at the elbow and the wrist, are called the radioulnar articulations. Because of the interosseous membrane and these articulations, any disruption or fracture of one bone is usually accompanied by fracture to the other (image 1) [1,4,9].
If only one bone appears to be fractured, the clinician should check the proximal and distal joints for injury to the other bone or the joint.
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- PERTINENT ANATOMY
- MECHANISM OF INJURY
- PHYSICAL FINDINGS
- Inspection and palpation
- Neurovascular examination
- Acute compartment syndrome
- Associated injuries
- RADIOGRAPHIC FINDINGS
- Radiographic technique
- Radiographic views and interpretation
- Specific fractures
- - Plastic deformations
- - Greenstick fractures
- - Complete fractures
- - Comminuted fractures
- Associated fractures
- INITIAL TREATMENT
- Absent pulse
- Compartment syndrome
- Analgesia and splinting
- INDICATIONS FOR ORTHOPEDIC CONSULTATION OR REFERRAL
- DEFINITIVE CARE
- Plastic deformation
- Greenstick fracture
- Complete fracture
- - Open fracture
- Comminuted fracture
- Immobilization and casting basics
- FOLLOW-UP CARE
- Home pain management
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS