Forearm fractures - middle third

Case contributed by Leonardo Lustosa

Presentation

Patient slipped and hit his right forearm onto a ledge. Obvious forearm deformity upon physical examination.

Patient Data

Age: 12 years
Gender: Male
x_ray

Radiographs revealed a middle third both-bone forearm fracture.

There is nearly 100% displacement of the radius on the coronal plane and >100% displacement on the sagittal plane. The radius is shortened by 11.28 mm.

There is <100% displacement of the ulna on both the coronal and the sagittal plane. The ulna is shortened by 25.93 mm.

Case Discussion

Forearm fractures are the most common long bone fractures in children.

These fractures usually fare well with non-operative treatment. In the present case, however, if better reduction and correction of angulation is not achieved by closed reduction and immobilization, operative treatment must be considered.

Acceptable residual angulation after closed reduction is still a topic of debate amongst orthopedic surgeons. Most literature considers an acceptable angulation of midshaft fractures to be <15º. Furthermore, up to 100% of translation can be accepted, and a shortening <1 cm.

In the present case, the fracture was unstable and acceptable reduction was not achieved.

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