THE OPERATIVE MANAGEMENT OF PEDIATRIC FRACTURES OF THE UPPER EXTREMITY

Abstract

The vast majority of pediatric fractures of the upper extremity can and should be treated with closed reduction, immobilization, and close follow-up. However, there is an ongoing debate in the orthopaedic community regarding the exact role of surgical management in the treatment of pediatric fractures 1. In the past two decades, operative management of certain fractures (e.g., percutaneous pinning of displaced supracondylar fractures) has provided better results than closed management. Surgical management is clearly indicated for certain injuries, such as those requiring anatomical realignment of the physis or articular surface. Increasingly, however, surgical management is being used to maintain optimal alignment or to allow early motion. In many such cases, both nonoperative and operative methods have yielded good results and have vocal advocates. Certain technical advances, such as flexible intramedullary fixation and bioreabsorbable implants, have further increased enthusiasm for operative management of pediatric fractures. The goal of these lectures is to describe current concepts in the operative management of selected pediatric fractures of the upper extremity. The focus is on specific indications, techniques, and potential complications in managing fractures of the forearm and elbow in children. The full scope of pediatric fracture management is a subject for textbooks. For introductory information and descriptions of techniques of successful nonoperative management, the reader is directed to comprehensive sources 2. Forearm fractures are among the most common orthopaedic injuries in children, accounting for 30% to 50% of all pediatric fractures 3,4. Historically, almost all forearm fractures in skeletally immature patients were treated nonoperatively. Recent information regarding functional outcomes, however, has challenged many of the traditional tenets of forearm fracture care. Furthermore, with the advent of newer technology, instrumentation, and techniques of fracture fixation, the treatment options have expanded 5. ### Distal Radial Fractures Because of their proximity to the distal radial …