Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Dec;105(3):225-234.
doi: 10.1007/s12306-020-00684-6. Epub 2020 Oct 14.

Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature

G Caruso  1 , E Caldari  1 , F D Sturla  1 , A Caldaria  2 , D L Re  1 , P Pagetti  1 , F Palummieri  1 , L Massari  1
Affiliations
Review

Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature

G Caruso et al. Musculoskelet Surg. 2021 Dec.

Abstract

Purpose: This narrative review intends to summarize the most important and relevant data on diagnosis and treatment of pediatric forearm fractures and to describe the characteristics and advantage of each therapeutic option.

Methods: We conducted a literature research considering peer-reviewed papers (mainly clinical trials or scientific reviews) using the string "forearm fracture AND epidemiology" or "forearm fracture AND diagnosis or " forearm fracture AND treatment" or "forearm fracture AND casting" or "forearm fracture AND surgery". Studies were identified by searching electronic databases (MEDLINE and PubMed) till April 2020 and reference lists of retrieved articles. Only English-language articles were included in the review.

Results: Conservative management with cast immobilization is a safe and successful treatment option in pediatric forearm fractures. Surgical indication is recommended when an acceptable reduction cannot be obtained with closed reduction and casting. Surgical treatment options are intramedullary nail, plating and hybrid fixation.

Conclusions: There is not a unique consensus about fracture management and treatment. Further studies are necessary to create univocal guidelines about optimal treatment, considering new techniques and available technologies.

Keywords: Casts; Conservative treatment; Forearm; Fractures; Pediatric; Surgery; Trauma.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict interests.

Figures

Fig. 1
Fig. 1
Anatomy of the forearm with the insertion point of the main muscles
Fig. 2
Fig. 2
The correct procedure to make a forearm cast is illustrated. Cast is molded with anterior and posterior pressure applied over the intraosseous membrane. Medial and lateral molding above the humeral condyles will prevent distal sliding of the cast
Fig. 3
Fig. 3
These illustrations show the different stages of conservative management of pediatric both-bone forearm fractures: AP and lateral radiographic projections of the fracture at the time of diagnosis (up), AP and lateral projections after forearm plaster cast (middle), AP and lateral projections after cast removal (down)
Fig. 4
Fig. 4
AP and lateral radiographic projection of both-bone forearm fractures treated with double elastic intramedullary nails technique
Fig. 5
Fig. 5
AP and lateral radiographic projection of both-bone forearm fractures treated with single elastic intramedullary nail technique
Fig. 6
Fig. 6
AP and lateral radiographic projections of post-operative treatment of a bi-osseous forearm fractures with two plates
Fig. 7
Fig. 7
Flowchart treatment proposal, based on the available data in literature
See this image and copyright information in PMC

References

    1. Naranje SM, Erali RA, Warner WC, Sawyer JR, Kelly DM. Epidemiology of pediatric fractures presenting to emergency departments in the United States. J Pediatr Orthop. 2016;36(4):e45–48. - PubMed
    1. Joeris A, Lutz N, Wicki B, Slongo T, Audigé L. An epidemiological evaluation of pediatric long bone fractures: a retrospective cohort study of 2716 patients from two Swiss tertiary pediatric hospitals. BMC Pediatr. 2014;14(1):314. - PMC - PubMed
    1. Ryan LM, Teach SJ, Searcy K, Singer SA, Wood R, Wright JL, et al. Epidemiology of pediatric forearm fractures in Washington. DC J Trauma. 2010;69(4 Suppl):S200–S205. doi: 10.1097/TA.0b013e3181f1e837. - DOI - PubMed
    1. Salvi AE. Forearm diaphyseal fractures: which bone to synthesize first? Orthopedics. 2006;29(8):669–671. - PubMed
    1. Herman MJ, Marshall ST. Forearm fractures in children and adolescents: a practical approach. Hand Clin. 2006;22(1):55–67. - PubMed