UMEM Educational Pearls

Category: Pediatrics

Title: Pediatric forearm fractures (submitted by Emilie Cobert, MD, MPH)

Keywords: Bayonet, fracture reduction technique, radius (PubMed Search)

Posted: 12/16/2011 by Mimi Lu, MD
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Pediatric forearm fractures:

- 75% occur at the distal forearm, often include both radius and ulna
- Risk factor for failure of closed management: increased initial fracture displacement
- Increasing use of operative management for these unstable fractures due to unsuccessful closed reduction
- Bayoneted fracture (two fracture fragments that lie next to each other rather than in end-to-end contact) often require pin repair.
- Attempt closed reduction in ED with such maneuvers as traction-countertraction, can be aided by finger traps.
- Other newer techniques include Lower Extremity-aided Fracture Reduction (LEAFR) maneuver (Eichinger, 2011) which utilizes the unaided single provider's lower extremity to place counter-traction on the arm while using dominant hand of provider for traction and the free second hand of provider to realign the deformity (place your flexed knee interlocked just proximal to patient's flexed elbow)
- Splint distal forearm fractures in pronation in long-arm cast.
Bottom line: The LEAFR is a newer clinically effective technique for reduction of bayoneted distal radius fractures in children for single providers resulting in decreased rates of operative management.
Eichinger, JK, et al. A New Reduction Technique for Completely Displaced Forearm and Wrist Fractures in Children: A Biomechanical Assessment and 4-year Clinical Evaluation. J Pediatr Orthop. 2011 Oct-Nov;31(7):e73-9.