Surgical Interventions for Diaphyseal Fractures of the Radius and Ulna in Children

This week, as part of the Child Health Emergency Medicine Social Media Campaign, we are highlighting a Cochrane summary on surgical interventions for treating diaphyseal fractures of the radius and ulna in children. This review was selected for the TREKK Evidence Repository on fractures.

Key Messages:

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Related TREKK Resources:

Cochrane Summary:

Fractures of the shafts of the forearm bones in children are common injuries and occur after a fall on an outstretched hand. There are two bones in the forearm: the radius and the ulna. After a fall either one or both bones may fracture.

The shape of forearm bones are important for the twisting motion of the hand, such as in receiving change from a shop keeper with an open palm (supination) or turning a key in a door (turning the palm facing down – pronation). Treatment of the forearm fracture aims to restore the shape of the bones such that supination and pronation ability is restored.

The first stage of treatment involves manipulating (setting) the bones to the correct shape. This is usually done under anaesthesia. The second stage involves stabilising the fractured bones either with a plaster cast (conservative treatment) or metal implants (surgical treatment).

This review aimed to examine the evidence from randomised controlled trials comparing conservative versus surgical methods and trials comparing different surgical methods for treatment of these fractures. We hoped to find which are the best methods in terms of function and complications. In spite of a thorough search we found no evidence from properly conducted studies to help inform decisions on treatment of these fractures.

Authors’ Conclusions:

There is a lack of evidence from randomized controlled trials to inform on when surgery is required and what type of surgery is best for treating children with fractures of the shafts of the radius, ulna or both bones.

Check out the Full Cochrane Systematic Review Below:

Abraham, A., Kumar, S., Chaudhry, S., Ibraham, T. (2011). Surgical interventions for diaphyseal fractures of the radius and ulna in children. Cochrane Database Syst Rev, 11, CD007907. doi: 10.1002/14651858.CD007907.pub2

Take Home Message:

This is a topic where more research is needed before strong recommendations for treatment can be made. Check out the resources developed by TREKK for more information on what is currently known. Follow us @Cochrane_Child and @TREKKca for more on this topic throughout the week.

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This post is part of a weekly blog series highlighting pediatric emergency medicine (PEM) focused Cochrane summaries and other key resources selected by TREKK.

Published by arrangement with John Wiley & Sons.