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Forearm Fractures
Emily S. Orscheln, MD; A. Carlson Merrow, Jr., MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          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
              • 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 cortical deformity on compression side
                • Component of buckling often accompanies physeal fracture → look for subtle extension of lucency to growth plate
              • Greenstick: Cortical disruption on tension side
              • Plastic deformity: Smooth abnormal curvature of diaphysis without cortical interruption
            • Segmental/bifocal: More than 1 fracture site (or fracture + dislocation) of same bone
              • Uncommon outside of distal ulna
              • Fracture sites are 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

                            • Image Interpretation Pearls

                              • Reporting Tips

                                Selected References

                                1. Laor T et al: Describing pediatric fractures in the era of ICD-10. Pediatr Radiol. 50(6):761-75, 2020
                                2. Sengab A et al: Risk factors for fracture redisplacement after reduction and cast immobilization of displaced distal radius fractures in children: a meta-analysis. Eur J Trauma Emerg Surg. 46(4):789-800, 2020
                                3. Iles BW et al: Differentiating stable buckle fractures from other distal radius fractures: the 1-cm rule. Pediatr Radiol. 49(3):358-64, 2019
                                4. Wacker EM et al: Pediatric proximal radial shaft fractures treated nonoperatively fail to maintain acceptable reduction up to 70% of the time. J Orthop Trauma. 33(10):e378-84, 2019
                                5. Naranje SM et al: Epidemiology of pediatric fractures presenting to emergency departments in the United States. J Pediatr Orthop. 36(4):e45-8, 2016
                                6. Sferopoulos NK: Segmental forearm bone injuries in children: classification and treatment. J Orthop Traumatol. 17(3):215-21, 2016
                                7. Herren C et al: Ultrasound-guided diagnosis of fractures of the distal forearm in children. Orthop Traumatol Surg Res. 101(4):501-5, 2015
                                8. Little JT et al: Pediatric distal forearm and wrist injury: an imaging review. Radiographics. 34(2):472-90, 2014
                                9. Vopat ML et al: Treatment of diaphyseal forearm fractures in children. Orthop Rev (Pavia). 6(2):5325, 2014
                                10. Beutel BG: Monteggia fractures in pediatric and adult populations. Orthopedics. 35(2):138-44, 2012
                                11. Zlotolow DA: Pediatric forearm fractures: spotting and managing the bad actors. J Hand Surg Am. 37(2):363-6; quiz 366, 2012
                                12. Flynn JM et al: Eleven years experience in the operative management of pediatric forearm fractures. J Pediatr Orthop. 30(4):313-9, 2010
                                13. Bae DS: Pediatric distal radius and forearm fractures. J Hand Surg Am. 33(10):1911-23, 2008
                                14. Eberl R et al: Galeazzi lesions in children and adolescents: treatment and outcome. Clin Orthop Relat Res. 466(7):1705-9, 2008
                                15. 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

                                      • Clinical Issues

                                        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
                                            • 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 cortical deformity on compression side
                                              • Component of buckling often accompanies physeal fracture → look for subtle extension of lucency to growth plate
                                            • Greenstick: Cortical disruption on tension side
                                            • Plastic deformity: Smooth abnormal curvature of diaphysis without cortical interruption
                                          • Segmental/bifocal: More than 1 fracture site (or fracture + dislocation) of same bone
                                            • Uncommon outside of distal ulna
                                            • Fracture sites are 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

                                                          • Image Interpretation Pearls

                                                            • Reporting Tips

                                                              Selected References

                                                              1. Laor T et al: Describing pediatric fractures in the era of ICD-10. Pediatr Radiol. 50(6):761-75, 2020
                                                              2. Sengab A et al: Risk factors for fracture redisplacement after reduction and cast immobilization of displaced distal radius fractures in children: a meta-analysis. Eur J Trauma Emerg Surg. 46(4):789-800, 2020
                                                              3. Iles BW et al: Differentiating stable buckle fractures from other distal radius fractures: the 1-cm rule. Pediatr Radiol. 49(3):358-64, 2019
                                                              4. Wacker EM et al: Pediatric proximal radial shaft fractures treated nonoperatively fail to maintain acceptable reduction up to 70% of the time. J Orthop Trauma. 33(10):e378-84, 2019
                                                              5. Naranje SM et al: Epidemiology of pediatric fractures presenting to emergency departments in the United States. J Pediatr Orthop. 36(4):e45-8, 2016
                                                              6. Sferopoulos NK: Segmental forearm bone injuries in children: classification and treatment. J Orthop Traumatol. 17(3):215-21, 2016
                                                              7. Herren C et al: Ultrasound-guided diagnosis of fractures of the distal forearm in children. Orthop Traumatol Surg Res. 101(4):501-5, 2015
                                                              8. Little JT et al: Pediatric distal forearm and wrist injury: an imaging review. Radiographics. 34(2):472-90, 2014
                                                              9. Vopat ML et al: Treatment of diaphyseal forearm fractures in children. Orthop Rev (Pavia). 6(2):5325, 2014
                                                              10. Beutel BG: Monteggia fractures in pediatric and adult populations. Orthopedics. 35(2):138-44, 2012
                                                              11. Zlotolow DA: Pediatric forearm fractures: spotting and managing the bad actors. J Hand Surg Am. 37(2):363-6; quiz 366, 2012
                                                              12. Flynn JM et al: Eleven years experience in the operative management of pediatric forearm fractures. J Pediatr Orthop. 30(4):313-9, 2010
                                                              13. Bae DS: Pediatric distal radius and forearm fractures. J Hand Surg Am. 33(10):1911-23, 2008
                                                              14. Eberl R et al: Galeazzi lesions in children and adolescents: treatment and outcome. Clin Orthop Relat Res. 466(7):1705-9, 2008
                                                              15. Carson S et al: Pediatric upper extremity injuries. Pediatr Clin North Am. 53(1):41-67, v, 2006