Forearm Fractures (3)

Question 1

How common are these fractures?

Where does is usually occur?

What are the causes?

Answer 1

➊ It accounts for > 40% of all childhood fractures. About 3 out of 4 (75% of) forearm fractures in children occur at the wrist end of the radius.

➋ Distal radius (75%)

➌ * Fall onto an outstretched arm
* Fall directly on the forearm
* Direct blow to the forearm

Question 2

What are the different types of this?

Answer 2

Torus fracture (“Buckle” fracture) - The topmost layer of bone on one side is compressed, causing the other side to bend away from the growth plate. This is a stable fracture.

Greenstick fracture - Fracture extends through a portion of the bone, causing it to bend on the other side.

Galeazzi fracture - Fracture affecting both bones of the forearm. Displaced fracture in the radius and a dislocation of the radio-ulnar joint.

Monteggia fracture - Fracture affecting both bones of the forearm. Fracture in the ulna and a dislocation of the proximal radial head. This is a very severe injury and requires urgent care.

N.B. Remember the mneumonic GRUesume MURder! Galeazzi: R-radial fracture + U-ulnar dislocation. Monteggia: U-ulnar fracture + R- radial head dislocation.

Metaphyseal fracture - Fracture is across the upper/lower portion of the shaft.

Growth plate fracture (“Physeal” fracture) - Fracture at the growth plate, most commonly at the distal radius. This type of fracture requires prompt attention as the growth plate helps determine the future length and shape of the mature bone.

Question 3

G

How is it typically managed?

Answer 3

Nonsurgical Treatment:
* Casts/splints can be applied for the stable fractures, such as buckle fractures.
* If fracture has become angled, simple closed reduction and manipulation can be done before the cast/splint is applied

Surgical Treatment:
This will likely be considered if:
* Open fracture (bone has broken through the skin) due to the risk for infection
* Unstable fracture (ends of broken bones won’t stay aligned)
* Broken bone ends can’t be aligned through manipulation alone
* Dsiplaced bone segments
* Bones have already began to heal at an angle/improper position