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Acceptable Alignment of Forearm Fractures in Children: Open Reduction Indications

Price, Charles T. MD

Journal of Pediatric Orthopaedics: March 2010 - Volume 30 - Issue - p S82-S84
doi: 10.1097/BPO.0b013e3181bbf1b4

Acceptable alignment of forearm fractures in children is controversial. An initial attempt at closed reduction in the emergency department is appropriate for the majority of these injuries. Complex or unstable fractures and those that cannot be maintained in acceptable alignment are candidates for surgical intervention. As a general guideline, fractures with complete displacement will remodel satisfactorily. However, angulation may be more critical for preservation of forearm rotation. Up to 15 degrees angulation is recommended as maximum angulation for mid-shaft and distal-shaft fractures in children younger than 8 years old. But 10 degrees is recommended as the maximum acceptable angulation for older children and proximal shaft fractures. When malunion is greater than this, remodeling is unreliable but may occur for fractures with less than 20-30 degrees of angulation.

Orthopaedic Surgery, University of Central Florida College of Medicine, Orlando

Reprints: Charles T. Price, MD, Professor of Orthopaedic Surgery, University of Central Florida College of Medicine, Director of Pediatric Orthopaedic Education, Orlando Health, Associate Director Orthopaedic Residency Program Orlando Health, 86 West Underwood Street, FL 32806, Orlando. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.