Avoid ordering 'x-ray arm' as it is better to have images focused to the region of local tenderness. If the injury is to the mid forearm or the pain is poorly localised, a 'forearm x-ray' should be ordered. What radiological investigations should be ordered?Īppropriate analgesia and splinting for pain relief prior to x-ray is required.Ī 'wrist x-ray' request will provide anteroposterior (AP) and lateral views of the distal forearm and wrist. Remember to always examine the elbow for associated injuriesĥ. Deformity depends on the degree of physeal displacement. There is usually pain and tenderness directly over the fracture site, and limited range of motion in the wrist and hand. Commonly there is an associated ulna fracture (greenstick, physeal or styloid).įigure 1: Dorsal (posterior) displacement of the distal fragment is usually the result of a fall on an extended wrist. Extension of the wrist at the time of injury causes the distal fragment to be displaced dorsally (posteriorly). The most common mechanism of injury is a fall on an outstretched hand (Figure 1). Distal radial physeal fractures are uncommon in children younger than five years. The Salter-Harris type II fracture is the most common type. The peak age for injury to the growth plate is in the pre-adolescent growth spurt. How common are they and how do they occur? Radial physeal fractures can occur in isolation or be associated with an ulna fracture (greenstick, physeal or styloid). Physeal fractures are classified by the Salter-Harris classification and whether the radius, ulna, or both bones are injured. Not seen in acute injury diagnosis usually made in retrospect Refer to orthopaedics - usually requires open reduction and internal fixation (ORIF)įracture clinic as per post-operative orders Refer to orthopaedics if unable to perform closed reductionįracture clinic within 5 days of immobilisation Reduction is not advisable after ≥5 days of initial injury Undisplaced: Below-elbow plaster backslab or removable splint for 4 weeksĭisplaced: Closed reduction and below-elbow plaster backslab for 4 weeks Rarely associated with growth disturbance Salter-Harris fracture type and frequency What are the potential complications associated with this injury?.What is the usual ED management for this fracture?.Do I need to refer to orthopaedics now?.When is reduction (non-operative and operative) required?.What radiological investigations should be ordered?. How common are they and how do they occur?.Distal radial physeal fractures - Fracture clinics
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