Management of Pediatric Forearm Fractures

Fractures of the radius and ulna are among the most common injuries in childhood, representing up to 40 per cent of paediatric fractures. Management begins with prompt clinical assessment and radiographic classification into diaphyseal, metaphyseal or distal‐radius patterns, with particular attention to growth plate integrity. In minimally displaced injuries, closed reduction followed by cast immobilisation remains a safe and effective approach, leveraging children’s remarkable remodelling capacity. Surgical intervention is indicated when acceptable alignment cannot be maintained or in older children with reduced remodelling potential. Techniques include elastic stable intramedullary nailing, which preserves soft tissues and offers early mobilisation, and plate‐screw fixation, which affords rigid anatomical reduction. Hybrid fixation combines both methods in both‐bone fractures to optimise operative time and cosmesis. Restoration of the radial bow and rotational alignment is critical to regain full pronation and supination. Implant selection must consider long-term biomechanics and the burden of removal procedures, spurring interest in bioresorbable materials. Global guidelines vary in thresholds for angulation and operative timing, reflecting diverse access to imaging and specialist expertise, yet recent consensus efforts aim to unify age-based criteria. Telemedicine and standardised training modules have enhanced follow-up and minimised complication rates.

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Management of Pediatric Forearm Fractures publication trend

The graph below shows the total number of articles in management of pediatric forearm fractures across all publications each year (not limited to Nature Index journals).

Technical terms

Cast immobilisation: Application of a rigid external shell to maintain fracture alignment during healing.

Closed reduction: Manual realignment of bone fragments without surgical exposure.

Elastic Stable Intramedullary Nailing (ESIN): Flexible titanium nails inserted into the medullary canal to stabilise paediatric fractures while permitting controlled micromotion.

Biodegradable Intramedullary Nail (BIN): Resorbable polymer implants that provide internal support and gradually degrade, eliminating the need for removal.

Hybrid fixation: Combined use of intramedullary nailing for one bone and plate-screw fixation for the other in both-bone forearm fractures.

References

1. Management of pediatric forearm fractures: what is the best therapeutic choice? A narrative review of the literature. MUSCULOSKELETAL SURGERY (2020).
2. Randomized Controlled Trial of the Clinical Recovery and Biodegradation of Polylactide-co-glycolide Implants Used in the Intramedullary Nailing of Children’s Forearm Shaft Fractures with at Least Four Years of Follow-Up. Journal of Clinical Medicine (2021).
3. Pilot Study and Preliminary Results of Biodegradable Intramedullary Nailing of Forearm Fractures in Children. Children (2022).
4. Comparison of Three Different Surgical Fixation Techniques in Pediatric Forearm Double Fractures. Cureus (2021).