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Self-Assessment Questions

Orthopaedic Surgery

Answer 3
  1. Accept the current reduction and convert to a long arm cast. Fractures of the distal radius typically occur after a fall onto an outstretched hand, resulting in apex-volar angulation of the fracture. Anatomic reduction is not always necessary for pediatric fractures due to the significant potential for remodeling as bones continue to grow. This remodeling potential is accentuated in distal fractures and in children younger than age 10 years.3 Distal radius locking plates are not used to fix pediatric fractures, as they may lead to premature closure of the distal radius physis. Similarly, intramedullary fixation of distal radius fractures is not commonly used because it is difficult to maintain good fracture stability and may also lead to early physeal closure. Repeat closed reduction to improve fracture alignment would be difficult at this point after the injury. The fracture pattern as seen in Figure 2 typically does not affect the distal-radial-ulnar joint in pediatric patients and resplinting in supination is not necessary. In patients younger than 9 years, complete displacement (bayonet apposition), 15 degrees of angulation, and 45 degrees of malrotation are acceptable (fracture position in Figure 2 is within these limits), and casting for 4 to 6 weeks remains the best option.3

     Noonan KJ, Price CT. Forearm and distal radius fractures in children. J Am Acad Orthop Surg 1998;6:146–56.

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