Pediatric Forearm Fracture Management Strategies

Management of forearm fractures in children encompasses a spectrum of conservative and surgical approaches tailored to fracture type, displacement, patient age and risk of loss of alignment. Stable injuries such as torus (buckle) fractures often respond well to removable splints or soft bandages with immediate discharge and minimal follow-up, reducing healthcare utilisation and radiation exposure. More unstable patterns—greenstick, complete metaphyseal or diaphyseal fractures, and injuries involving both radius and ulna—may require closed reduction and cast immobilisation. Persistent displacement or high-risk features prompt consideration of percutaneous fixation with Kirschner wires (K-wires) or elastic stable intramedullary nailing (ESIN), aiming to preserve growth plates and facilitate early motion. Decision algorithms increasingly incorporate radiographic indices and patient-specific risk factors to guide the need for operative stabilisation. Evolving evidence supports risk stratification to balance the benefits of anatomical realignment against procedural morbidity, while minimising follow-up visits and imaging in low-risk cases. International practice patterns reflect variation in resource availability and clinician preference, underscoring the importance of standardised pathways that optimise functional recovery and cost-effectiveness.

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Pediatric Forearm Fracture Management Strategies publication trend

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

Technical terms

Torus (buckle) fracture: An incomplete fracture in which one cortex of the bone buckles without cortical disruption on the opposite side, resulting in inherent stability.

Kirschner-wire fixation (K-wire fixation): A percutaneous surgical technique using thin stainless steel wires to maintain fracture reduction, often augmented by a short period of immobilisation.

Elastic stable intramedullary nailing (ESIN): A minimally invasive method in which prebent flexible nails are inserted into the medullary canal to stabilise long-bone fractures while preserving periosteal blood supply and allowing early mobilisation.

Redisplacement: The loss or alteration of initial fracture alignment following reduction and immobilisation, necessitating potential secondary intervention.

References

1. Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. The Lancet (2022).
2. Risk factors for fracture redisplacement after reduction and cast immobilization of displaced distal radius fractures in children: a meta-analysis. European Journal of Trauma and Emergency Surgery (2019).
3. Displaced distal radius fractures in children, cast alone vs additional K-wire fixation: a meta-analysis. European Journal of Trauma and Emergency Surgery (2018).
4. Distal radius fractures in children: substantial difference in stability between buckle and greenstick fractures. Acta Orthopaedica (2009).
5. Are Unnecessary Serial Radiographs Being Ordered in Children with Distal Radius Buckle Fractures?. Radiology Research and Practice (2018).
6. A multicentre prospective randomized equivalence trial of a soft bandage and immediate discharge versus current treatment with rigid immobilization for torus fractures of the distal radius in children. Bone & Joint Open (2020).