Fracture - radius and ulna shaft (diaphyseal) fractures
Fracture - radius and ulna shaft (diaphyseal) fractures
General notes
Assess the fracture type and its initial displacement and management prior to clinic. Carry out neurovascular exam (?nerve entrapment or compartment syndrome) and assess the cast.
Monitor for redisplacement of the fracture
Image reproduced with permission from RCH Melbourne:
(http://www.rch.org.au/clinicalguide/guideline_index/fractures/Radialulna_shaft_diaphysis_fractures_Emergency_Department/)
Greenstick fracture
Image reproduced with permission from RCH Melbourne:
(http://www.rch.org.au/clinicalguide/guideline_index/fractures/Radialulna_shaft_diaphysis_fractures_Emergency_Department/)
Management
closed reduction with immobilisation in above elbow cast for six weeks. Three point moulding is required
Fracture clinic review
Within 7-10 days with x-ray
At 6 weeks with x-rays out of cast and clinical review
Discharge advice for family
One in twenty shaft fractures will refracture. This occurs primarily in the first six months of injury. The risk is higher immediately after cast removal
Contact sports should be avoided for a minimum of six weeks after cast removal
Plastic deformation
Image reproduced with permission from RCH Melbourne:
(http://www.rch.org.au/clinicalguide/guideline_index/fractures/Radialulna_shaft_diaphysis_fractures_Emergency_Department/)
Management
Plastic deformation is often unrecognised
Radiographic findings may be subtle
It is most commonly seen in the ulna
Usually requires general anaesthetic
Fracture clinic review
7-10 days with x-ray
At 6 weeks with x-rays out of cast and clinical review
Discharge advice for family
One in twenty shaft fractures will refracture. This occurs primarily in the first six months of injury. The risk is higher immediately after cast removal
Contact sports should be avoided for a minimum of six weeks after cast removal
Complete fracture
Image reproduced with permission from RCH Melbourne:
(http://www.rch.org.au/clinicalguide/guideline_index/fractures/Radialulna_shaft_diaphysis_fractures_Emergency_Department/)
Management
Closed reduction with immobilisation in above elbow cast for 6 weeks
Three point moulding is required
Consider further 2 weeks forearm cast thereafter in children over 8 years
Fracture clinic review
Within 7-10 days with x-ray and again thereafter before three weeks post injury, with a check x-ray as remanipulation may be required up to 21 days.
Discharge advice for family
One in twenty shaft fractures will refracture. This occurs primarily in the first six months of injury. The risk is higher immediately after cast removal
Contact sports should be avoided for a minimum of six weeks after cast removal