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Proximal fractures of the forearm in children

Paula Schweich, MD
Section Editor
Susan B Torrey, MD
Deputy Editor
James F Wiley, II, MD, MPH


Proximal forearm fractures are less common than other childhood forearm fractures and comprise a subset of elbow fractures. They include radial head and neck fractures, ulnar olecranon, ulnar coronoid process fractures, and Monteggia fractures. These fractures typically occur from a fall on an outstretched arm and are associated with falls during basketball, football, and extreme sports (eg, skateboarding). Early assessment should focus on identifying an open fracture, neurovascular compromise, acute compartment syndrome, and/or associated injuries. The key for a good outcome is the correct diagnosis at the time of injury. Radiographic diagnosis may be challenging in children because much of the pediatric elbow is composed of cartilage, and fractures can be very subtle.

Initial care of nondisplaced fractures consists of splinting, pain control, and measures to decrease swelling. Displaced fractures frequently require urgent orthopedic consultation and operative reduction. This topic review will address proximal fractures of the forearm.

Evaluation and treatment of distal or midshaft forearm fractures are discussed separately. (See "Midshaft forearm fractures in children" and "Distal forearm fractures in children: Initial management".)

Evaluation and treatment of other elbow fractures are also reviewed elsewhere. (See "Evaluation and management of condylar elbow fractures in children" and "Epicondylar and transphyseal elbow fractures in children" and "Evaluation and management of supracondylar fractures in children".)


Proximal forearm fractures, also considered a type of elbow fracture, include radial head and neck fractures as well as ulnar olecranon and coronoid process fractures. These are the least common type of forearm fracture in children. However, with the popularity of football and basketball and an increase in extreme sports, there has been an accompanying increase in elbow injuries, including proximal forearm fractures [1-3]. Radial head and neck fractures in particular, previously rare in pediatrics, have increased dramatically in teenagers with the increased popularity of extreme skateboarding, ATV riding, and other high-risk sports.


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Literature review current through: Sep 2016. | This topic last updated: Sep 22, 2015.
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