21/07/2026
Pediatric Distal Radius & Ulna Fractures
Account for ~40% of pediatric fractures. Management is guided by the exceptional remodeling potential of the distal radial physis (~80% of radial length).
1. Fracture Classification
Torus (Buckle):
Stable cortex impaction; intact periosteum.
Greenstick:
Unicortical disruption with plastic deformation.
Complete:
Both cortices disrupted; prone to translation/rotation.
Salter-Harris (Physeal):
Type II is most common. Low risk of growth arrest if managed gently.
Key Rule: Rotational malalignment does not remodel and must be corrected manually.
3. Management Strategy
Non-Operative
Torus: Removable splint or short arm cast for 3–4 weeks.
Displaced/Angulated: Closed reduction \rightarrow long arm cast with 3-point molding for 4–6 weeks. Check X-rays weekly for 2–3 weeks.
Operative (CRPP)
Indications:
Unstable reduction, secondary displacement, complete off-ended fractures in older children, or floating elbow.
Fixation:
Smooth 1.6\text{ mm} or 2.0\text{ mm} K-wires. Avoid repeated passes across the physis.
4. Primary Complications
Loss of Reduction: Most common; usually due to poor cast index/molding.
Physeal Arrest: Rare (7 days) or aggressive manipulation.
Median Nerve Neurapraxia: Secondary to volar displacement or cast pressure.
In our case, this is the xrys of 7 years old deaf and dumb child of pre mainpulation amd after manipulation and splintage.
