Pediatric emergency medicine trisk 3482 3482
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fractures are typically seen in the setting of ipsilateral radial metaphyseal fracture;
inability to achieve similar reduction in both bones is highly predictive of
redisplacement.
Clinical Considerations
Clinical Recognition. Children with distal radius and ulna fractures will typically
present with focal arm pain, swelling, or deformity. It should be noted that wrist
pain may also be the chief complaint with more proximal injuries, for example,
radial head fractures.
Triage Considerations. These children may present with obvious deformity and
significant pain or with minimal deformity and mild pain. Patients with plastic
deformities, greenstick, and torus fractures may present several days after the
injury. The injured extremity should be immobilized and pain management
addressed.
Clinical Assessment. Localized swelling and tenderness commonly accompany
distal radial fractures and can guide interpretation of the radiographic studies.
Management. Radiographs that include the entire forearm, including the elbow
and wrist, should be obtained to identify all possible injuries to the extremity.
Several common fracture patterns exist in injuries of the distal radius and ulna,
and management varies by diagnosis ( Fig. 111.30 ). Some cases may be managed
with only gentle manipulation without sedation or through the use of local
anesthetics or blocks, eliminating the potential risks and costs associated with
sedation.
Torus fracture . With torus fractures, often the location of the soft tissue swelling
on the radiographs helps highlight the position of the fracture. These fractures
may be subtle, evident on only one projection and then only as a minor
irregularity in the contour of the cortex. When a torus fracture is identified, a
short arm volar splint or, if the swelling is minimal, a short arm cast for 3 to 4
weeks is recommended. A removable splint for 3 to 4 weeks has been shown to
be as effective as casting, with the additional advantage of interfering less with
physical functioning and activities. Follow-up may occur with the primary care
clinician or with the orthopedic surgeon, and serial radiographs to guide
management are infrequently needed.
