Acceptable Alignment of Forearm Fractures in Children: Open Reduction Indications

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.