The brachioradialis dorsiflexes and deviates radially the distal fragment during a distal third fractures. Fractures that happened in the middle third are altered by the pronator quadratus more distally, which pronates the distal fragment, meantime the impact of bicep on the more proximal fragment is negated by the pronator teres, causing the fragment to remain in neutral position. The supinator and bicep flex and supinate the proximal fragment, when there is a proximal fracture. The bicep attaches proximally at the bicipital tuberosity on the anterior medial radius. Understanding the deforming forces is essential to the reduction in both-bone forearm fractures (Fig. However, single bone forearm fractures of the ulna or radius should always raise suspicion for a Monteggia or Galeazzi fracture dislocation, respectively. Single bone forearm fractures are far less common and are typically the result of direct trauma. Pediatric forearm fractures typically follow indirect trauma, such as a fall on an outstretched hand coupled with a rotational component. Additional remodeling can also be attributed to elevation of the thick osteogenic periosteum after fracture. This polarization of growth shows why distal fractures demonstrate a higher remodeling potential than do fractures closer to the elbow. The distal radial and ulnar growth plates are responsible for 75% and 81% of the longitudinal growth of each bone, respectively. The interosseous membrane is higher strain proximally in neutral and pronation, and is higher strain distally when in supination. The radial bow, an apex lateral bend in the radius, increases the range of pronation. Radius and ulna are attached by the proximal annular ligament, by the interosseous membrane along the diaphysis, and distally by the ligaments of the distal radioulnar joint and triangular fibrocartilage complex. Anatomically, the ulna is relatively straight and static, it plays a more important role in maintaining forearm stability, especially when subjected to buckling and torsional stress. Understanding pediatric forearm anatomy offers important guidelines for treatment in the nonoperative and operative settings. Both forearm bones were fractured in 50.1% of cases of forearm injuries and there were significantly more males than females (63.6% vs. found forearm fractures to be significantly more frequent in school age children (65%) and adolescents (63%) compared to infants (42%) and preschool children (50%). Forearm fractures account for 17.8% of all fractures in pediatric age. using the 2010 NEISS report, estimated in children aged 0 to 19 years, 5,333,733 emergency room (ER) visits, of which 788,925 (14.7%) were fracture related. Further studies are necessary to create univocal guidelines about optimal treatment, considering new techniques and available technologies.įorearm fractures are the most common type of fractures in the pediatric population, but, to date, no comprehensive overviews of their epidemiology are available. There is not a unique consensus about fracture management and treatment. Surgical treatment options are intramedullary nail, plating and hybrid fixation. Surgical indication is recommended when an acceptable reduction cannot be obtained with closed reduction and casting. ResultsĬonservative management with cast immobilization is a safe and successful treatment option in pediatric forearm fractures. Only English-language articles were included in the review. Studies were identified by searching electronic databases (MEDLINE and PubMed) till April 2020 and reference lists of retrieved articles.

We conducted a literature research considering peer-reviewed papers (mainly clinical trials or scientific reviews) using the string “forearm fracture AND epidemiology” or “forearm fracture AND diagnosis or “ forearm fracture AND treatment” or “forearm fracture AND casting” or “forearm fracture AND surgery”. This narrative review intends to summarize the most important and relevant data on diagnosis and treatment of pediatric forearm fractures and to describe the characteristics and advantage of each therapeutic option.

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