Treatment of Pediatric Forearm Fractures

Initial Assessment and Classification

The American Academy of Orthopaedic Surgeons recommends obtaining at least 3 radiographic views (posteroanterior, lateral, and oblique) to fully characterize the fracture pattern 1
The American College of Radiology defines significant displacement as >3mm displacement or >10° of angulation 2
A true lateral radiograph post-reduction is essential to assess alignment and evaluate for distal radioulnar joint (DRUJ) involvement 3, 4, 2
The American College of Radiology suggests that fractures of the radius, ulna, tibia, fibula, or femur in children <1 year are suspicious for abuse, though at age 11 this is less of a concern 5

The American Academy of Orthopaedic Surgeons recommends removable splints for minimally displaced fractures 2
Rigid immobilization is preferred over removable splints for displaced fractures, according to the American Academy of Orthopaedic Surgeons 2, 1

The American Academy of Orthopaedic Surgeons advises immediately initiating active finger motion exercises following diagnosis to prevent finger stiffness 3, 6, 2, 7
Finger motion does not adversely affect adequately stabilized fractures regarding reduction or healing, according to the American Academy of Orthopaedic Surgeons 3, 6, 7
Hand stiffness results from pain, swelling, cast obstruction, or patient apprehension, as noted by the American Academy of Orthopaedic Surgeons 3, 6

The American Academy of Orthopaedic Surgeons recommends obtaining follow-up radiographs at approximately 3 weeks and at the time of immobilization removal 1
Reevaluation is necessary for any patient with unremitting pain during follow-up, as this may indicate complications such as compartment syndrome, malunion, or DRUJ instability, according to the American Academy of Orthopaedic Surgeons 3, 4, 2, 7

A home exercise program is an effective option for patients prescribed therapy after the immobilization period ends, as suggested by the American Academy of Orthopaedic Surgeons 3, 4, 6, 2, 7
Studies comparing home exercise programs to supervised therapy showed no significant difference in outcomes for uncomplicated fractures, according to the American Academy of Orthopaedic Surgeons 3, 4

The American Academy of Orthopaedic Surgeons recommends assessing for DRUJ instability, which can lead to poor outcomes if missed 3, 4, 2
Rotational malalignment does not remodel and must be corrected, as noted by the American Academy of Orthopaedic Surgeons 1
Prolonged immobilization without finger motion significantly increases the risk of permanent stiffness, according to the American Academy of Orthopaedic Surgeons 3, 6, 1

The American Academy of Pediatrics recommends that children with healing distal both-bone forearm fractures at 8 weeks post-injury can progress to sport-specific movements without contact or impact, such as throwing motions without a ball or swimming strokes in air, as part of a gradual return to activity 8