Displaced Distal Forearm Fractures in Children

Introduction: Distal forearm fractures are the most common cause for morbidity in otherwise healthy children. There is a wide variety of pediatric fractures. When sufficient force is applied, a complete ‘adult-type’ fracture may occur. By nature, these fractures are very unstable because of disruption of both cortices. Maintaining reduction is key for successful treatment. However, there is no consensus on how to maintain reduction in completely displaced distal forearm fractures in children. We evaluate success rate of closed reduction and cast immobilization. Methods: Subjects were identified through emergency department administration in a single level II trauma center in the Netherlands. Subjects with displaced distal forearm fractures under the age of 14 years were included. All patients were treated with closed reduction and a three-point mold cast. Success is defined as preservation of reduction until consolidation. Results: Treatment with closed reduction and cast immobilization was successful in 58.8% of the cases. In none of the subjects a re-intervention was indicated. Conclusion: Most of the time the growth plate has enough remodeling potential. However, in completely displaced distal forearm fractures in children K-wire placement may be required to warrant reduction after initial reduction. Level of evidence: Level IV, therapeutic.