Pediatric Forearm Fracture
last authored: July 2011, David LaPierre
last reviewed:
Introduction
Pediatric forearm fractures usually cause fracture to both radius and ulna. With the Monteggia pattern of fracture-dislocation, an ulnar fracture and radial dislocation occurs. Isolated ulnar fracture can follow a direct blow to the forearm, often while shielding the face.
The Case of Sam R.
Sam is a 6 year-old boy who tripped and fell onto the sidewalk while running. His forearm is clearly deformed.
- how do you diagnose his injury?
- how should he be treated?
Causes and Risk Factors
A fall on an outstretched arm is usual.
Pathophysiology
Signs and Symptoms
- history
- physical exam
History
Patients will experience pain and swelling.
Physical Exam
Tenderness and swelling are usual.
Assess the function of distal nerves, including the median, ulnar, and radial.
Decreased nerve function, or extreme pain on finger extension, should raise concern of compartment syndrome.
Investigations
- lab investigations
- diagnostic imaging
Lab Investigations
Labs are not indicated.
Diagnostic Imaging
Imaging should include AP and lateral films, including the wrist and elbow.
Ensure the radial head aligns with the capitellum; with a Monteggia pattern, the radius is usally dislocated anteriorly, by may also be posterior or lateral.
Differential Diagnosis
With fractures, it is important to consider:
- child abuse
- osteogenesis imperfecta (thin bony cortices)
- osteomyelitis (fever)
- pathologic fracture, through bone cyst or tumour
- septic arthritis of the elbow
Treatments
Closed reduction is usually possible, if diagnosed and treated early. Immobilization should be via long arm cast.
Open reduction or reconstruction may be necessary if treatment is delayed.
Consequences and Course
Complications include malunion, compartment syndrome, or loss of rotation, and are more likely the more proximal the fracture.
Resources and References
Topic Development
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