Figure 1
Figure 1
An X-ray showing the AP wrist and the distal forearm.
Clinical History
This case concerns an unusual presentation of a complex forearm fracture in a 14-month-old male baby.
Imaging Findings
A 14-month-old male baby on a holiday, presented to a local hospital, as he had fallen off a swing and had sustained an injury to his right forearm. An examination revealed a grossly deformed arm,
but no distal neurovascular deficit was found. There were no other associated injuries. Radiographs of the forearm revealed displaced fractures of the radius and the ulna shafts at the junction of
the middle and distal thirds. There was a further displaced fracture of the ulna placed distal to this, but this fracture was proximal to and not extending into the distal radio-ulna joint. There was
no associated dislocation of this joint (Figs. 1, 2). In view of the patient’s age, and the severity of the deformity, a procedure involving an open reduction and internal fixation, using
dynamic compression plates, was performed. On reduction of the main fragments, the fracture in distal ulna was reduced into an anatomically correct position and was therefore left alone. The patient
was immobilised with a plaster above the elbow for 6 weeks (Figs. 3, 4).
Discussion
Radius and ulna shaft fractures account only for 3.4% of all children’s fractures (1). In boys, there is a bimodal peak, the first occurring at around 9 years of age and the second between 13
and 14 years of age. The majority (75%) of these fractures are metaphyseal with 20% involving the middle third. Only a few (<4%) involve a disruption of either the distal or the proximal
radio-ulna joints (2). The most common mechanism of injury involves a fall with the hand outstretched and bearing the weight of the body, as it hits the ground. Up to 10 degrees of deformity in the
sagittal plane can be accepted and it has been proven that there is no residual functional deficit as a result of this (3). Greater deformities can be accepted in younger patients and with those
fractures which occur closer to the growth plate, as remodelling can occur. However, after the age of 10, this capacity diminishes. A rotational deformity does not remodel with growth, although
greater degrees of deformity (up to 30 degrees) may not necessarily affect the functional outcome (4). In a male aged 14 years, a perfect anatomical reduction should be the aim, to achieve a fully
functional outcome. Different surgical methods are possible, including the use of plates and screws, elastic intramedullary nails or k-wires, and percutaneous k-wire fixation. This fracture was
treated with compression plates to promote primary bone healing, and, by reducing the two main fractures, ligamentotaxis in the third fracture has been reduced. Fractures of the radius and ulna
shafts in children remain difficult to treat, as there are many variables which must be taken into consideration when choosing treatment options.
Differential Diagnosis List
A segmental forearm fracture with an intact DRUJ.
Final Diagnosis
A segmental forearm fracture with an intact DRUJ.
References
[1]
Landin LA
Fracture Patterns in Children. Analysis of 8682 Fractures With Special Reference to Incidence, Aetiology and Secula Changes in a Swedish Urban Population, 1950 – 79. Acta Chir. Scand. Suppl. 202:1983. (PMID: 6574687)
[2] Matthews LS, Kaufer H, Gover DF, Sonstegard DA. The Effects of Supination-Pronation of Angular Malalignment of Fractures of Both Bones of the Forearm. JBJS. 64A:14-17,1982. (PMID: 7054197)
Case information
| URL: | https://eurorad.org/case/3104 |
| DOI: | 10.1594/EURORAD/CASE.3104 |
| ISSN: | 1563-4086 |
Figure 2
Figure 2
An X-ray showing the lateral wrist and the distal forearm.
Figure 3
Figure 3
An X-ray showing the post-operative AP forearm.
Figure 4
Figure 4
An X-ray showing the post-operative lateral forearm.
Figure 1
An X-ray showing the AP wrist and the distal forearm.
Figure 2
An X-ray showing the lateral wrist and the distal forearm.
Figure 3
An X-ray showing the post-operative AP forearm.
Figure 4
An X-ray showing the post-operative lateral forearm.