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Forearm Fractures
A. Carlson Merrow, Jr., MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Diagnostic Checklist

          TERMINOLOGY

          • Synonyms

            • Physeal, Salter-Harris, Monteggia, Galeazzi, buckle (torus), plastic or bowing, greenstick, "both bone" fractures
          • Definitions

            • Complete fracture: Macroscopic fracture line traverses entire bony diameter (both cortices on single view)
              • Physeal (Salter-Harris): Fracture through cartilaginous growth plate, typically with adjacent bony involvement
              • Monteggia: Radial head dislocation + proximal ulnar shaft fracture
              • Galeazzi: Distal radial fracture + distal ulnar dislocation
            • Incomplete fracture: Macroscopic fracture line does not traverse entire bony diameter
              • Buckle: Focal convex (bump) deformity of cortex (compression side)
              • Plastic (bowing) deformity: Smooth, flowing abnormal curvature of bony shaft
              • Greenstick: Frank interruption of 1 cortex (tension side) without fracture line through opposite cortex
            • Segmental/bifocal: More than 1 fracture site (or fracture + dislocation) of same bone
              • Uncommon outside of distal ulna
              • Fracture sites typically remote

          IMAGING

          • General Features

            • Radiographic Findings

              • Ultrasonographic Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        CLINICAL ISSUES

                        • Presentation

                          • Natural History & Prognosis

                            DIAGNOSTIC CHECKLIST

                            • Reporting Tips

                              Selected References

                              1. Naranje SM et al: Epidemiology of pediatric fractures presenting to emergency departments in the United States. J Pediatr Orthop. 36(4):e45-8, 2016
                              2. Sferopoulos NK: Segmental forearm bone injuries in children: classification and treatment. J Orthop Traumatol. ePub, 2016
                              3. Herren C et al: Ultrasound-guided diagnosis of fractures of the distal forearm in children. Orthop Traumatol Surg Res. 101(4):501-5, 2015
                              4. Little JT et al: Pediatric distal forearm and wrist injury: an imaging review. Radiographics. 34(2):472-90, 2014
                              5. Vopat ML et al: Treatment of diaphyseal forearm fractures in children. Orthop Rev (Pavia). 6(2):5325, 2014
                              6. Beutel BG: Monteggia fractures in pediatric and adult populations. Orthopedics. 35(2):138-44, 2012
                              7. Zlotolow DA: Pediatric forearm fractures: spotting and managing the bad actors. J Hand Surg Am. 37(2):363-6; quiz 366, 2012
                              8. Flynn JM et al: Eleven years experience in the operative management of pediatric forearm fractures. J Pediatr Orthop. 30(4):313-9, 2010
                              9. Bae DS: Pediatric distal radius and forearm fractures. J Hand Surg Am. 33(10):1911-23, 2008
                              10. Eberl R et al: Galeazzi lesions in children and adolescents: treatment and outcome. Clin Orthop Relat Res. 466(7):1705-9, 2008
                              11. Carson S et al: Pediatric upper extremity injuries. Pediatr Clin North Am. 53(1):41-67, v, 2006
                              Related Anatomy
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                              Related Differential Diagnoses
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                              References
                              Tables

                              Tables

                              KEY FACTS

                              • Terminology

                                • Imaging

                                  • Pathology

                                    • Diagnostic Checklist

                                      TERMINOLOGY

                                      • Synonyms

                                        • Physeal, Salter-Harris, Monteggia, Galeazzi, buckle (torus), plastic or bowing, greenstick, "both bone" fractures
                                      • Definitions

                                        • Complete fracture: Macroscopic fracture line traverses entire bony diameter (both cortices on single view)
                                          • Physeal (Salter-Harris): Fracture through cartilaginous growth plate, typically with adjacent bony involvement
                                          • Monteggia: Radial head dislocation + proximal ulnar shaft fracture
                                          • Galeazzi: Distal radial fracture + distal ulnar dislocation
                                        • Incomplete fracture: Macroscopic fracture line does not traverse entire bony diameter
                                          • Buckle: Focal convex (bump) deformity of cortex (compression side)
                                          • Plastic (bowing) deformity: Smooth, flowing abnormal curvature of bony shaft
                                          • Greenstick: Frank interruption of 1 cortex (tension side) without fracture line through opposite cortex
                                        • Segmental/bifocal: More than 1 fracture site (or fracture + dislocation) of same bone
                                          • Uncommon outside of distal ulna
                                          • Fracture sites typically remote

                                      IMAGING

                                      • General Features

                                        • Radiographic Findings

                                          • Ultrasonographic Findings

                                            • MR Findings

                                              • Imaging Recommendations

                                                DIFFERENTIAL DIAGNOSIS

                                                  PATHOLOGY

                                                  • General Features

                                                    CLINICAL ISSUES

                                                    • Presentation

                                                      • Natural History & Prognosis

                                                        DIAGNOSTIC CHECKLIST

                                                        • Reporting Tips

                                                          Selected References

                                                          1. Naranje SM et al: Epidemiology of pediatric fractures presenting to emergency departments in the United States. J Pediatr Orthop. 36(4):e45-8, 2016
                                                          2. Sferopoulos NK: Segmental forearm bone injuries in children: classification and treatment. J Orthop Traumatol. ePub, 2016
                                                          3. Herren C et al: Ultrasound-guided diagnosis of fractures of the distal forearm in children. Orthop Traumatol Surg Res. 101(4):501-5, 2015
                                                          4. Little JT et al: Pediatric distal forearm and wrist injury: an imaging review. Radiographics. 34(2):472-90, 2014
                                                          5. Vopat ML et al: Treatment of diaphyseal forearm fractures in children. Orthop Rev (Pavia). 6(2):5325, 2014
                                                          6. Beutel BG: Monteggia fractures in pediatric and adult populations. Orthopedics. 35(2):138-44, 2012
                                                          7. Zlotolow DA: Pediatric forearm fractures: spotting and managing the bad actors. J Hand Surg Am. 37(2):363-6; quiz 366, 2012
                                                          8. Flynn JM et al: Eleven years experience in the operative management of pediatric forearm fractures. J Pediatr Orthop. 30(4):313-9, 2010
                                                          9. Bae DS: Pediatric distal radius and forearm fractures. J Hand Surg Am. 33(10):1911-23, 2008
                                                          10. Eberl R et al: Galeazzi lesions in children and adolescents: treatment and outcome. Clin Orthop Relat Res. 466(7):1705-9, 2008
                                                          11. Carson S et al: Pediatric upper extremity injuries. Pediatr Clin North Am. 53(1):41-67, v, 2006