Pediatric emergency medicine trisk 3481 3481
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reduction is necessary with displaced fractures. ED management should include
pain control and immobilization with the arm in a position of comfort for any
presumed fracture until diagnostic imaging and definitive care can be obtained.
CLINICAL PEARLS AND PITFALLS
While the risk of growth arrest after distal radius physeal fracture is only
about 4%, growth arrest of the distal ulna after physeal fracture has
been reported to occur in up to 55% of cases making referral for
orthopedic follow-up important.
Fracture type varies with age and skeletal maturity: torus and
greenstick fractures are frequent in children less than 10 years old,
growth plate fractures become increasingly common in children over 10
years, and complete fractures more typical in adolescents.
Torus fractures may be subtle on radiographs; therefore, careful review
in the setting of a suggestive history and physical examination is
warranted.
Ulnar styloid fractures are often accompanied by either a torus or
physeal fracture of the radius.
While there are high rates of asymptomatic nonunion in the healing of
ulnar styloid fractures, fractures through the base of the styloid may
interrupt the triangular fibrocartilage complex resulting in instability of
the distal radial ulnar joint and requiring orthopedic follow-up.
Current Evidence
Distal forearm fractures are by far the most common of all the fractures that occur
during childhood and adolescence. Fortunately, with the exception of occasional
nerve entrapment at the time of reduction of a complete fracture, significant
neurovascular complications are rare. The distal radial physis accounts for 60% of
the growth of the radius and typically closes at 14 to 16 years old. Consequently,
the capacity for remodeling up through early adolescence for fractures of this
region is significant due to proximity to the biologically active growth plates.
Acceptable alignment in terms of angulation and displacement for children under
age 8 years old is more forgiving than in older children. It is important to
reference alignment guidelines specific to both age and bony location of injury at
the time of evaluation. A general rule for acceptable alignment includes less than
20 degrees of angulation for children younger than 10 years and less than 10
degrees of angulation for children older than 10 years. Distal ulnar metaphyseal
