Presentation
Fall onto the outstretched hand after jumping off a sofa. Mild forearm deformity upon physical examination.
Patient Data
Greenstick fractures at the middle third of the radial and ulnar shafts with volar angulation.
The radial fracture line is located on the proximal half of the middle third of the shaft, proximal to the pronator teres insertion.
Case Discussion
Forearm fractures are the most common long bone fractures in children. Fall onto the outstretched hand is the main mechanism of injury. Due to skeletal immaturity, they may present as greenstick fractures.
Pediatric forearm fractures can be practically classified considering 3 main characteristics:
bone involvement: radius, ulna, or both
level: distal, middle, or proximal third
fracture pattern: complete, greenstick, bowing, or comminuted
Unlike adults, most forearm fractures in children can be managed non-operatively.
The reduction maneuver and the position of immobilization can be guided by this simple yet clinically practical classification.
If a middle third radial fracture is present, special attention is given to the pronator teres insertion, which dictates the immobilization position.
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