Edited by Nattaly Greene, David Evans - 7/1/2021
Descriptor
- Incomplete (Buckle) and Complete (Nondisplaced, displaced, Bayonet apposition)
- Apex dorsal vs. volar angulation
Exam Pearls
- Pain, swelling, and tenderness localized to the wrist. Gross deformity may or may not be present. Assess for puncture wounds
- Evaluate active and passive range of motion of the forearm, wrist, and hand
- In non verbal children; assess for decreased spontaneous movement of the extremity
Workup
Radiographs: AP/Lateral of wrist and forearm. Include elbow films if any tenderness at the elbow. Other imaging: May consider a CT scan to evaluate intra articular fracture
Labs: None
Other: Classification depending on location of fracture in relation to distal physis- Salter Harris classification
Fracture with dislocation/associated injuries - Galeazzi(distal ⅓ radius with associated DRUJ injury)
Management
Need for acute intervention: Yes, immobilization +/- reduction
Immobilization without reduction
- Unicortical or bicortical fractures with <10 degrees of angulation
- Torus/buckle fracture - may use prefabricated removable wrist splint
Immobilization with reduction
- Closed reduction under conscious sedation followed by casting
- Fractures with >10-20 degrees of angulation
- Salter Harris I or II with unacceptable angulation
Reduction technique: Recreate and exaggerate deformity, pull traction maintaining deformity, and realign using tension on the intact periosteum
Acceptable Angulation Parameters
Weight-bearing and range of motion: Nonweightbearing
Type of immobilization: Long arm bivalved cast with good three point mold
Admission or discharge status: Discharge with one week follow up with repeat wrist Xrays. Admit if open fracture or any neruovascular compromise
Anticoagulation: None
Antibiotics: None unless open fracture
Surgical Indications
Absolute: Open fracture which will need formal irrigation and debridement