Pediatric forearm fractures. Diagnosis, therapy and possible complications

Nonoperative management of forearm fractures in children has a good outcome in over 90% of all cases. In our own series (n = 102) there were only six children (6.1%) with significant limitation (> 25 degrees) of forearm rotation. In these cases two out of four (50%) were located in the proximal third but only two out of 68 in the distal third. Indications for operative stabilization are the following: compound fractures, fractures associated with vessel and nerve injuries, joint fractures, dislocated fractures of the middle and proximal third, and Monteggia/Galeazzi injuries. As implants intramedullary devices are preferred. Twenty children were managed with elastic IM rods between 1994 and 1995 at our institution. At final follow-up all had a free ROM and a maximal axial malalignment of less than 5 degrees. In the region of the distal forearm K-wires are useful. Plates play a dominant role for corrections and nonunions; external skeletal stabilization is indicated for temporary fixation in compound fractures.