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CHAPTER 8 • Fractures of the Distal Radius and Ulna

Indications/Contraindications

age, the degree of acceptable angulation has ranged from 10 to 25 degrees (Table 8-1). 63,108,114,149,163,171,211 Criteria for what constitutes acceptable frontal plane deformity have been more uniform. The fracture tends to displace radially with an apex ulnar angulation. This defor- mity also has remodeling potential, 154,223 but less so than sag- ittal plane deformity. Most authorities agree that 10 degrees or less of acute malalignment in the frontal plane should be accepted. Greater magnitudes of coronal plane malalignment may not remodel and may result in limitations of forearm rotation. 42,44,54,62,210 In general, 10 to 30 degrees maximum of sagittal plane angulation, 10 to 15 degrees maximum of radioulnar deviation, and even complete bayonet apposition will reliably remodel in younger children with at least 2 years of significant growth remaining. 50,70,97,223

Nonoperative Treatment of Distal Radius Fractures: INDICATIONS AND CONTRAINDICATIONS Indications Relative Contraindications

Torus fractures Nondisplaced fractures Displaced fractures within acceptable radiographic alignment Displaced fractures amenable to closed reduction and immobilization Late-presenting physeal fractures Distal radial physeal stress fractures

Open fractures Neurovascular compromise or excessive swelling precluding circumferential cast immobilization

Irreducible fracture in unacceptable alignment Unstable fractures failing initial reduction and cast immobilization

A

Figure 8-24.  A: AP and lateral views of displaced radial physeal fracture. B: Healed malunion 1 month after radial physeal fracture.

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B