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Pediatric Forearm Fracture S52.209A 813.23

Stryker / Howmedica

 

synonyms: both bone forearm fracture, radius and ulna fracture

Pediatric Forearm Fracture ICD-10

 

A- initial encounter for closed fracture

B- initial encounter for open fracture type I or II

C- initial encounter for open fracture type IIIA, IIIB, or IIIC

D- subsequent encounter for closed fracture with routine healing

E- subsequent encounter for open fracture type I or II with routine healing

F- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing

G- subsequent encounter for closed fracture with delayed healing

H- subsequent encounter for open fracture type I or II with delayed healing

J- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing

K- subsequent encounter for closed fracture with nonunion

M- subsequent encounter for open fracture type I or II with nonunion

N- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion

P- subsequent encounter for closed fracture with malunion

Q- subsequent encounter for open fracture type I or II with malunion

R- subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion

S- sequela

Pediatric Forearm Fracture ICD-9

  • 813.23(fracture of the radius and ulna; closed)
  • 813.33(fracture of the radius and ulna; open)

 

Pediatric Forearm Fracture Etiology / Epidemiology / Natural History

  • Associated with tromplines, monkey bars, obesity (Davidon P, J Peadiatr Child Health 2003;39:664), poor milk intake (Gouldig A, J Am Diet Assoc 2004;104:250).
  • Generally fall onto outstretched arm.

Pediatric Forearm Fracture Anatomy

  • radial tuberosity and radial styloid should be on opposite sides of the radius.
  • Ulnar styloid is on the opposite side of the ulna form the coronoid process.

Pediatric Forearm Fracture Clinical Evaluation

  • Pain, swelling, deformity in forearm.
  • Document neurovascular exam before and after any treatment.

Pediatric Forearm Fracture Xray / Diagnositc Tests

  • radial tuberosity and radial styloid should be on opposite sides of the radius.
  • Ulnar styloid is on the opposite side of the ulna form the coronoid process.

Pediatric Forearm Fracture Classification / Treatment

  • <10 y/o generally heal and remodel with no loss of rotation
  • >10 y/o high risk of functional deficit, ORIF if unstable by closed means
  • Acceptable reduction: complete displacement, angulation <10°(Price CT, JPO 1990;10:505-712): distal 1/3=20°, middle third=15°, proximal 1/3=10° for girls 8 years of age or younger and boys age 10 or younger 
  • acceptable reduction:<10 y/o angular correction of 1degree  per month or 10degree  per year, no rotational deformity, bayonet apposition with <1 cm shortening: >10yrs should be managed like adults(no deformity accepted)
  • Reduction Analgesia: propofol/fentanyl (Godambe SA, Pediatrics 2003:112:116), ketamine/midazolam, axillary block (Kriwanek K:, JPO 2006:26:737), nitrous oxide with hematoma block (Luhmann JD, Pedicatrics 2006:118:e1078).
  • Immobilize in LAC that incorporates thumb.
  • Pediatric Forearm Fracture IM Nailing 25575 indicated for refractures with displacement, open fx, displaced proximal forearm fx, unstable fx, unacceptable alignment following CR, polytrauma
  • ORIF with plates is generally not recommend in pediatric patients due to an increased risk of subsequent fracture at the end of the plates.

Pediatric Forearm Fracture Associated Injuries / Differential Diagnosis


Pediatric Forearm Fracture Complications

  • poor results associated with proximal fxs, age >10, rotational malalignment, loss of radial bow
  • Malunion=angulation >10, displacement >50%,  malrotation, encroachment on interosseous membrane.  Angulation of 20-30 degrees may be observed for 3 months for remodeling.  Angulation >30 degrees corrective osteotomy is indicated.  Restoration of motion is best if osteotomy is performed within 1year of injury. (Trousdale RT, JBJS Am 1995;77:894-902)
  • Price CT, Scott DS, Kurzner ME, et al: Malunited forearm fractures in children.  J Pediatr Orthop 1990;10:705-712.
  • Kay S, Smith C, Oppenheim WL: Both-bone midshaft forearm fractures in children.  J Pediatr Orthop 1986;6:306-310.
  • refracture: greenstick fx’s have greatest risk of refracture.  Strongly consider ORIF/flexible nails (Schwartz N, JBJS Br 1996;78:740-744)
  • compartment syndrome
  • delayed union
  • Non-union (usually involves the ulna)
  • infection
  • superficial radial nerve palsy (generally transient)
  • Growth arrest

Pediatric Forearm Fracture Follow-up Care

  • Long arm cast for 6 wks

Pediatric Forearm Fracture Review References

  • Huber RI, et al.: Flexible intramedullary nailing as fracture treatment in children. JPO, 1996;16:602-605.
  • Flynn ICL 2002 51:355-60
  • Flynn ICL 52:635-45
  • CORR 402-245
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