Paediatric forearm fracture fixation is an operation to realign and stabilise displaced forearm fractures in children that cannot be adequately managed with casting alone. Techniques include flexible nailing and, in older adolescents, plate fixation.
For most children: flexible titanium nails (TENS) are inserted through small incisions near the ends of the bones, crossing the fracture. For older adolescents near skeletal maturity: plate and screw fixation similar to adult technique may be used. The fracture is reduced under X-ray guidance. A cast or splint is applied for additional protection. The operation takes 45–90 minutes.
Surgery is recommended for displaced forearm fractures that cannot be reduced or maintained in a cast, open fractures, fractures with neurovascular compromise, and refractures.
Closed reduction and casting is the standard treatment for most paediatric forearm fractures and is successful in the majority. Remodelling potential in children is excellent, and mild angulation is acceptable depending on age and location.
Failed closed reduction attempt or unacceptable alignment on cast X-rays. Standard pre-assessment.
Accurate fracture alignment with stable fixation. Excellent healing potential in children. Most children regain full forearm rotation.
Protruding nail ends may cause skin irritation.
Temporary loss of rotation. Usually recovers fully.
At three to six months.
Healing with residual angulation or rotation. Remodelling usually corrects this in younger children.
Bridging bone between radius and ulna. Very rare in children.
Wound infection.
Requires urgent fasciotomy.
Very rare with careful technique.
After nail removal. Reduced by waiting for adequate healing.
General anaesthesia.
Cast or splint for four to six weeks. Nail removal at three to six months. Children recover forearm rotation faster than adults. Most return to full activity within six to eight weeks of fracture healing. Formal physiotherapy is rarely needed.
X-rays at one to two weeks, four to six weeks, and before nail removal.
Children have thicker periosteum (the membrane around bones), better blood supply, and excellent remodelling potential. Most fractures heal within four to six weeks.
Yes, in younger children. The growing bone can remodel and straighten mild angulation over months to years. The acceptable degree depends on the child's age and the fracture location.