Both Bone Forearm Fractures

Question 1

What are the normal boney anatomical relationships in the forearm?

Answer 1

Radial tuberosity and radial styloid are 180° from each other on an AP
Coronoid process and ulnar styloid are 180° from each other on a lateral radiograph

Question 2

What are the distal radial and ulnar physes responsible for longitudinal growth of the forearm?

Answer 2

Radial- 75%
Ulnar- 81%
Therefore distal forearm fxs have higher potential to remodel

Question 3

What are general guidelines for reducing pediatric both bone ffxs?

Answer 3

Apex-volar; reduce by pronation
Apex-dorsal; reduce by supination
Rotate palm toward the deformity
10-16% loss of reduction if not immobilized in same position of reduction

Question 4

How are pediatric both bone forearm fxs treated following reduction?

Answer 4

Eventually placed in long arm cast at 90 degrees elbow flexion; interosseous mold
f/u 1-2 weeks; if reangulated then general anesthesia and re-reduce
continue cast for 6-8 weeks
No contact sports for 4-6 months

Question 5

What are operative indications for a pediatric both bone forearm fracture?

Answer 5

Indications for OR
1) open
2) Shortly before skeletal maturity
3) irreducible fractures
4) Unstable fractures
5) Monteggia with unstable radial head and residual ulnar angulation
Pins and plaster, ORIF with plates, CRIF with nails, CRPP
Post-op immobilization in cast for 3-4 weeks