From the Guidelines
For a pediatric proximal radial metaphysis fracture, simple immobilization with a well-padded splint is the recommended treatment when fracture fragments are small, nonarticular, or minimally displaced. This approach is based on the principle that minimal intervention is often sufficient for such fractures, as stated in a study published in the American Family Physician 1. The goal of immobilization is to allow the fracture to heal while minimizing discomfort and potential complications.
When applying a splint, it's crucial to ensure that it is well-padded, particularly at bony prominences, to prevent pressure sores and discomfort. The splint should be secured with an elastic bandage to maintain the forearm in a neutral position, which helps in preventing pronation and supination. Immobilization typically lasts for several weeks, depending on the child's age and the severity of the fracture, with regular follow-up appointments necessary to monitor alignment and healing.
Key considerations for the management of pediatric proximal radial metaphysis fractures include:
- Immobilization with a well-padded splint for small, nonarticular, or minimally displaced fractures
- Regular follow-up appointments to monitor healing and alignment
- Pain management with weight-appropriate doses of acetaminophen or ibuprofen
- Monitoring for signs of complications such as excessive swelling, numbness, color changes in fingers, or increasing pain
It's essential to note that the management approach may vary depending on the specific characteristics of the fracture and the child's overall health status. However, simple immobilization remains a preferred initial treatment for pediatric proximal radial metaphysis fractures with minimal displacement or fragmentation, as supported by the available evidence 1.
From the Research
Pediatric Proximal Radial Metaphysis Fracture Splint
- The treatment of pediatric proximal radial metaphysis fractures can be challenging due to the high risk of complication, particularly loss of forearm rotation 2.
- Nonsurgical management of minimally displaced radial neck fractures produces excellent results in most patients, while displaced fractures may require closed or percutaneous reduction 2.
- The use of an above-the-elbow cast for 21 days can be an effective conservative treatment for proximal radius fractures in children 3.
- Elastic stable intramedullary nailing (ESIN) is a common surgical treatment for displaced proximal radius fractures in children, with good results and minimal complications 3.
- The stability of metaphyseal fractures can vary depending on their proximity to the diaphyseal metaphyseal junction (DMJ) or physis, with proximal segments exhibiting less angular stability than distal segments 4.
Treatment Options
- Conservative treatment: above-the-elbow cast for 21 days 3
- Surgical treatment: elastic stable intramedullary nailing (ESIN) 3
- Open reduction: may be necessary in some cases, but should be avoided whenever possible 3