Pediatric Distal Forearm Fractures/Management and Follow-Up Care

This module allows traditional bone setters, pre-hospital providers, clinical officers, nurses, nurse practitioners, and medical officers to become confident and competent in performing point-of-care ultrasound diagnostic imaging to rule out the presence of a pediatric distal forearm fracture and distinguish between buckle (torus) fractures and cortical break fractures to make appropriate referrals as part of the management of closed pediatric (< 16 years of age) distal forearm fractures in regions without access to X-ray imaging and orthopedic specialist coverage.^{[1][2][3][4][5][6][7][8][9]}

Management of Pediatric Distal Forearm Injuries[edit | edit source]

Principles of nonoperative treatment of children’s fractures

Indications for Referral[edit | edit source]

If any of these sonographic signs or clinical findings are present, the pediatric patient with a distal forearm injury must be referred for X-ray imaging:

• Cortical break fracture (apart from an isolated ulna styloid fracture or non-displaced, non-angulated ulna metaphyseal fracture)^[10]
• Secondary signs suggestive of a cortical break fracture
  • Angulation of the distal bone segment
  • Fracture < 1 cm of physis
  • Periosteal hematoma
  • Pronator quadratus hematoma
• Clinical suspicion e.g. ‘pain out of proportion’ despite normal sonographic findings^[10]

Management of Fracture Categories^[10]

#	Fracture Category	Management
1	No fracture	Conservative management with follow-up visit in 1 week[10]
2	Buckle (torus) fracture	Apply crepe bandage wrap, removable forearm splint, or backslab cast with follow-up visit in 1 week[9][10][11][12][13][14][15]
3	Other (including cortical break fractures or secondary signs suggestive of a cortical break fracture)	Referral for X-ray imaging and fracture management with manipulation, reduction, and/or surgery and immobilization in a plaster cast or equivalent as required[14]

Safe Splinting of Pediatric Distal Forearm Buckle (Torus) Fractures[edit | edit source]

• Splinting of pediatric buckle (torus) fractures of the distal forearm
• General introduction to nonoperative fracture care (1:01:56 minute video)
• Overview of cast, splint, orthosis and bandage techniques (English pdf only)
• Palmar short arm splint using synthetics (7:30 minute video)
• Compartment Syndrome
• Healing times

Acknowledgements[edit | edit source]

This work is funded by a grant from the Intuitive Foundation. Any research, findings, conclusions, or recommendations expressed in this work are those of the author(s), and not of the Intuitive Foundation.

References[edit | edit source]