What is the treatment for a radius and ulna fracture in an 11-year-old boy?

Treatment of Radius and Ulna Fracture in an 11-Year-Old Boy

For an 11-year-old boy with a radius and ulna fracture, treatment depends on the degree of displacement: minimally displaced fractures should be managed with rigid immobilization (not removable splints) and immediate active finger motion exercises, while significantly displaced fractures (>3mm displacement or >10° angulation) typically require surgical intervention. 1

Initial Assessment and Imaging

• Obtain at least 3 radiographic views (posteroanterior, lateral, and oblique) to fully characterize the fracture pattern 1
• A true lateral radiograph is essential to assess alignment and evaluate for distal radioulnar joint (DRUJ) involvement 1
• Fractures with >3mm displacement or >10° angulation are considered significantly displaced and generally require surgical management 1, 2

Treatment Algorithm Based on Displacement

For Minimally Displaced Fractures:

• Use rigid immobilization (cast or splint), NOT removable splints 1
• The American Academy of Orthopaedic Surgeons specifically recommends rigid immobilization over removable splints for displaced fractures 1
• Initial treatment typically involves a sugar-tong splint followed by a short-arm cast for a minimum of three weeks 3

For Significantly Displaced Fractures:

• Combined radius and ulna fractures with significant displacement generally require surgical correction 3
• Surgical intervention is indicated when anatomic alignment cannot be achieved or maintained with closed reduction 4

Critical Early Management: Prevent Finger Stiffness

Immediately initiate active finger motion exercises following diagnosis—this is one of the most important steps to prevent the functionally disabling complication of finger stiffness 1, 2, 5

• Finger motion does not adversely affect adequately stabilized fractures regarding reduction or healing 1
• Hand stiffness results from pain, swelling, cast obstruction, or patient apprehension—not from appropriate finger exercises 1
• This recommendation applies regardless of whether the fracture is treated operatively or nonoperatively 1

Follow-Up Protocol

• Obtain follow-up radiographs at approximately 3 weeks and at the time of immobilization removal 1, 2, 5
• Reevaluate any patient with unremitting pain during follow-up, as this may indicate complications such as compartment syndrome, malunion, or DRUJ instability 1
• Monitor for complications including skin irritation and muscle atrophy, which occur in approximately 14.7% of immobilization cases 2

Post-Immobilization Rehabilitation

• A home exercise program is an effective option for patients after the immobilization period ends 1
• Studies comparing home exercise programs to supervised therapy showed no significant difference in outcomes for uncomplicated fractures 1

Critical Pitfalls to Avoid

• Assess for DRUJ instability, which can lead to poor outcomes if missed 1
• Rotational malalignment does not remodel and must be corrected—this is particularly important in an 11-year-old who has limited remaining growth 1
• Avoid prolonged immobilization without finger motion, as this significantly increases the risk of permanent stiffness 1, 2
• Check for median nerve injury, which can complicate distal radius fractures 3

Special Considerations for Age 11

At age 11, this patient has some remaining growth potential but less remodeling capacity than younger children 4. Therefore:

• Acceptable angulation parameters are more strict than in younger children 4
• The goals of treatment are aimed at achieving satisfactory anatomic alignment within defined parameters based on growth remaining 4
• Most fractures can still be managed nonoperatively if alignment is acceptable, but surgical intervention is more commonly indicated than in younger children 4