Pediatric fracture: managed conservatively in plaster
A three and half year old boy
sustained injury to left forearm when he was pushed in school by fellow
student. After initial splintage, the child was brought to us in triage. The
child had deformed left forearm with pain, mild swelling but no gross abnormal
mobility, suggesting one bone was intact. X rays confirmed ulna bone had fractured in mid1/3rd region
with displacement, and there was plastic deformation of radius without obvious
cortical break. Such injuries are common in children as the bones are soft. The
bones tend to bend i.e. tolerate bending forces to a greater extent as compared
to adults. However, if force is severe and one of the forearm bones fractures,
then the other bone can get deformed in a plastic way. Such deformity can
result in ulna remaining displaced and result in overall visible deformity of
the forearm. The technique we used was gradual application of force opposite to
deformity, the force being gradually increased so as to correct the deformity
without fracturing the radius. This procedure was done under general
anesthesia. After correction of radius was achieved, confirmed under image
intensifier, an above elbow cast was given. As the radius was corrected, the
ulna fracture reduced on its own. There have been techniques described where
radius is fractured by the surgeon and then cast is given with both fractures
aligned anatomically. This technique however had many pitfalls especially since
it was difficult to counsel parents for a new facture.