![]() This condition can be remembered conveniently as the “Three A’s” of pediatric compartment syndrome. ![]() Cardinal signs of an acute compartment syndrome in a child include an agitated, inconsolable child appearing anxious and requiring an increasing amount of analgesia. Compartment syndrome in the uncooperative pediatric patient can, at times, be difficult to detect. Although soft-tissue swelling is expected in the setting of musculoskeletal trauma, the clinician should evaluate the forearm compartments and remain vigilant in identifying a developing compartment syndrome. The area of injury must be meticulously inspected for abrasions, lacerations, and the possibility of an open fracture. Initial evaluation of the patient with injury to the wrist and forearm should focus on the soft tissue and neurovascular status. Other activities with high fracture risk include handball, rollerblading, and playground activities. Snowboarding conferred a fracture risk 5 times greater than during trampoline-related activities and 4 times greater than in soccer. Randsborg and colleagues reported that activity-related fracture was most common during soccer and the highest fracture rate involved snowboarding. Pediatric fractures are more commonly seen in boys, with a male to female incidence ratio of 1.5.ĭistal radius fractures most often occur as a result of a fall onto the outstretched hand. The mean age at the time of fracture was 9.3 years in girls and 10.4 years in boys. Fractures of the distal radius were found to be the most common, representing 31% of all fractures in this patient population and tended to occur in the nondominant extremity in roughly 53% of cases. ![]() An annual fracture incidence of 180 per 10,000 in children younger than 16 years has been reported. This article reviews distal pediatric forearm fracture management with emphasis on potential complications and discussion related to recently published clinical data.įractures in the pediatric population are common. Recently published data have questioned long-held principles of nonoperative management for all fractures. Nonetheless, management of these injuries tends to differ quite significantly among clinicians. Many studies have discussed optimal treatment methods with regards to specific fracture patterns. The clinician often must balance the patient and family’s desire for early return to activity with the goal of long-term functionality of the involved limb. Regardless of the initial treatment plan, the treating surgeon must remain aware of the potential for both early and late complications that may affect outcomes. Treatment of these injuries may vary from simple casting and radiographic follow-up to urgent reduction and surgical fixation. Management of these injuries in pediatric patients should include assessment of the neurovascular status of the extremity, associated soft-tissue injury, and, most importantly, possible involvement of the physes of the radius and ulna. Fractures involving the distal radius and ulna are commonly seen in children and adolescents.
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