Treatment of Mid-Shaft Radius Fracture in a 7-Year-Old Child
For a mid-shaft radius fracture in a 7-year-old child, closed reduction with cast immobilization is the preferred treatment method, as it provides excellent healing potential with minimal complications. 1
Initial Management
- Closed reduction with cast immobilization is the standard of care for most pediatric forearm fractures, including mid-shaft radius fractures 1
- Most closed reductions can be performed in the emergency department with the patient under sedation or regional anesthesia 1
- If adequate reduction cannot be achieved in the emergency department, reduction in an operating room under general anesthesia may be necessary 1
Immobilization Approach
- Following successful reduction, immobilization with an above-elbow cast is typically recommended 2
- The most common duration for immobilization is approximately 4 weeks, though this may vary based on fracture characteristics and healing progress 3
- Active finger motion exercises should be performed during the immobilization period to prevent stiffness 4
Follow-Up Care
- Radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 4
- Clinical assessment should evaluate for proper alignment, rotation, and early signs of healing 2
Special Considerations
- Children under 7 years have excellent remodeling potential, which allows for acceptance of some degree of angulation that would not be acceptable in older children or adults 2
- If the fracture is unstable, significantly displaced (>3mm), or angulated (>10°), surgical management with fixation may be indicated 4, 1
- Surgical fixation is also considered for open fractures, refractures, or in cases involving multiple trauma 1
Potential Complications
- Complications such as skin irritation or muscle atrophy may occur in approximately 14.7% of immobilization cases 4
- Nonunion is exceptionally rare in pediatric forearm fractures 1
- Monitor for potential median nerve injury, which can occasionally complicate forearm fractures 2
Regional Practice Variations
- There are notable differences in treatment approaches between regions, with Nordic surgeons more likely to use surgical fixation compared to their US counterparts 3
- Despite emerging evidence supporting non-reduction of some pediatric fractures, most surgeons (83%) still prefer to reduce displaced radius fractures in children 3