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Pediatric Fractures of the Forearm, Wrist and Hand

Pediatric Forearm Fractures . Approximately 40% of children's long-bone fracturesMost from fall to an outstretched handUlna susceptible to direct blow night-stick" fractureForearm fracture incidence increasing Increased sporting activityIncreased body weight Neurologic injury rare (<1%). Pe

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Pediatric Fractures of the Forearm, Wrist and Hand

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    1. Pediatric Fractures of the Forearm, Wrist and Hand John A. Heflin, MD Original Author: Amanda Marshall, MD; March 2004 Revised: Steven Frick, MD; August 2006 John A. Heflin, MD; April 2011

    2. Pediatric Forearm Fractures Approximately 40% of children’s long-bone fractures Most from fall to an outstretched hand Ulna susceptible to direct blow “night-stick” fracture Forearm fracture incidence increasing Increased sporting activity Increased body weight Neurologic injury rare (<1%)

    3. Pediatric Forearm Fracture Locations Proximal Least common (approx 4%) due to decreased lever arm and increased soft tissue envelope Mid-shaft Account for 18 - 20% of both bone fractures Distal Account for >75% of radius and/or ulna fractures Approx 14% in distal physis

    4. Pediatric Forearm Fracture Types Plastic Deformation No cortical disruption Stress higher than elastic limit of bone Incomplete “Greenstick” Fractures One cortex intact Include buckle or torus type fractures Complete Fractures No cortex intact Most unstable

    5. Goals of Treatment Restore alignment and clinical appearance Limit injury to local soft tissues Prevention of further injury Pain relief Regain functional forearm rotation For ADL’s need 50 degrees supination, 50 degrees pronation

    6. Pediatric Forearm Primary ossification centers at 8 weeks gestation in both radius and ulna Distal physis provide most (80%) of longitudinal growth Distal epiphyses of radius appears at age 1 Distal epiphyses of distal ulna appears at age 5 Normal forearm rotation: Approx 90 degrees pronation Approx 90 degrees supination

    7. Plastic deformation

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