From the Guidelines
The treatment for a fractured arm is surgical stabilization for widely displaced fractures, as it results in equivalent or improved short-term patient-reported outcomes and reduced rates of nonunion or symptomatic malunion compared to nonsurgical treatment 1.
Treatment Options
- Surgical treatment: Indicated for widely displaced fractures, as it provides a faster functional and radiographic recovery, allowing for earlier return to work 1.
- Nonsurgical management: May be considered for minimally displaced fractures, but has a higher risk of malunion and nonunion, particularly for widely displaced fractures 1.
Considerations
- The type of surgical management used for fixation of clavicle fractures is not well established, with options including plate osteosynthesis and intramedullary fixation 1.
- The decision to treat a fractured arm surgically or nonsurgically should be made on a case-by-case basis, taking into account the individual patient's needs and fracture characteristics. Note: The provided evidence primarily discusses clavicle fractures, and the treatment of other types of arm fractures, such as distal radius fractures, may differ 1.
From the Research
Treatment Options for Fractured Arm
The treatment for a fractured arm depends on the type and severity of the fracture. The following are some common treatment options:
- Immobilization: Buckle (torus) fractures and greenstick fractures in children can be managed with immobilization 2.
- Casting: Nondisplaced or minimally displaced distal radius fractures in adults are initially treated with a sugar-tong splint, followed by a short-arm cast for a minimum of three weeks 2. Undisplaced fractures in children may be treated in a cast until the fracture site is no longer painful 3.
- Surgery: Isolated midshaft ulna (nightstick) fractures may be treated with surgery, depending on the degree of displacement and angulation 2. Combined fractures involving both the ulna and radius generally require surgical correction 2. Surgical treatment options for pediatric forearm fractures include intramedullary nail, plating, and hybrid fixation 4.
- Intramedullary fixation: Unstable diaphyseal fractures in children can be stabilized by intramedullary fixation of the radius and ulna 3.
- Plate and screw fixation: Unstable fractures in children that cannot be managed with other techniques may be treated with plate and screw fixation 3.
Specific Considerations
- Pediatric forearm fractures: The treatment of pediatric forearm fractures should take into account the continuing growth of the bones after the fracture has healed 3, 4.
- Complications: Fractures of the forearm may be complicated by median nerve injury 2 or other complications such as rotational deformity 3.
- New developments: New directions in the management of forearm fractures include the use of intramedullary fixation and locking plate technology 5.
Evidence-Based Medicine
- The ideal study to guide management of pediatric forearm fractures would be a randomly controlled trial comparing closed reduction and casting versus intramedullary nailing versus plating 6.
- There is currently limited high-level evidence to guide the management of pediatric forearm fractures, and further studies are necessary to create univocal guidelines about optimal treatment 4, 6.