What is the recommended treatment for mid diaphyseal fractures of the left distal ulna and radius in a 5-year-old?

Treatment of Mid Diaphyseal Fractures of Left Distal Ulnar and Radius in a 5-Year-Old

For mid diaphyseal fractures of the left distal ulna and radius in a 5-year-old child, closed reduction and immobilization with a cast is the recommended first-line treatment, with surgical intervention reserved only for unstable, significantly displaced, or angulated fractures. 1

Initial Management

• Assessment and Imaging:

  • Standard radiographs should be the first imaging modality to assess fracture pattern, displacement, and angulation 2
  • Evaluate for any associated soft tissue injuries or neurovascular compromise

• Classification of Pediatric Fracture Types:

  • Buckle (torus) fractures: Incomplete compression fractures without cortical disruption - common in children
  • Greenstick fractures: Incomplete fractures with cortical disruption on one side - also common in children 1

Treatment Algorithm

1. For minimally displaced or non-displaced fractures:

   • Closed reduction followed by immobilization with a long arm cast 1, 3
   • Cast immobilization typically for 3-4 weeks 2
   • Radiographic follow-up at 10-14 days to evaluate position and ensure maintenance of reduction 2

2. For displaced or angulated fractures:

   • Attempt closed reduction first
   • If closed reduction is successful and stable: immobilization with long arm cast
   • If closed reduction fails or is unstable: surgical intervention may be necessary 2, 3

3. Indications for surgical intervention:

   • Significant displacement or angulation
   • Failed closed reduction
   • Unstable reduction
   • Complex fractures with soft tissue interposition 2

Surgical Options (when indicated)

• Closed reduction with percutaneous pinning using Kirschner wires 3
• Open reduction and internal fixation for severely displaced fractures
• Intramedullary fixation is preferred in children older than 10 years, but rarely needed in a 5-year-old 3

Post-Treatment Management

• Immobilization Period:

  • Typically 3-4 weeks in a long arm cast 2
  • May be followed by a short arm cast for additional 1-2 weeks

• Rehabilitation:

  • Progressive range of motion exercises should begin after the immobilization period 2, 4
  • Directed home exercise program including active finger motion exercises 2
  • Full recovery typically expected within 6-8 weeks 2

Important Considerations for Pediatric Patients

• Children have excellent remodeling potential, especially in the younger age group (5 years)
• Greater degrees of angulation can be accepted in children compared to adults due to this remodeling capacity
• Fractures near the growth plate require special attention to avoid growth disturbances
• Avoid prolonged immobilization to prevent joint stiffness 2, 4

Potential Complications

• Joint stiffness (most common complication)
• Malunion or nonunion (rare in children)
• Growth disturbances if fracture involves or is near the growth plate
• Refracture 2

Follow-up Protocol

• Initial follow-up with radiographs at 10-14 days
• Subsequent follow-up at 3-4 weeks for cast removal
• Additional follow-up at 6-8 weeks to ensure proper healing and function 2

Pain Management

• NSAIDs for pain and inflammation control
• Oral analgesics and ice application for symptomatic relief 2

The excellent healing and remodeling potential in a 5-year-old child makes non-operative management the preferred approach in most cases, with surgical intervention reserved only for specific indications where closed reduction fails or is unstable.