FOREARM FRACTURES IN CHILDREN CAST TREATMENT WITH THE ELBOW EXTENDED

Fractures of the proximal forearm in young children may be unstable with the elbow flexed but stable with it in extension. Fifteen such fractures were managed by immobilisation in long-arm casts with the elbow extended. Only one patient had more than 15#{176}angulation at the time of bony union. All obtained normal elbow movement at two weeks and full forearm rotation at follow-up. No casts fell off. The extended elbow cast is awkward but it provides an alternative to internal fixation for some unstable fractures. Fractures of the proximal radius and ulna in the short, fat forearms of young children may be unstable with the elbow flexed but stable when the elbow is in extension. A conventional long-arm cast applied with the elbow flexed gives poor control of the proximal fragments and gravity causes the fractures to displace. Angular deformity often develops as the swelling subsides. Immobilisation of these fractures in their stable, extended position has rarely been recommended because the cast tends to slip off and because of the fear that the elbow may become stiff. Watson-Jones (1940) described treatment of these fractures in extension, reporting no problems in regaining elbow motion. However, in a later edition of the same book, Benjamin (1976) stated that forearm fractures in children should never be treated by immobilisation in extension; he advocated open opera-tion for these unstable fractures. King (1984) recom-mended treatment of the rare type II or posterior Monteggia fracture in children with the elbow in extension. Apley (1977) considered that long-arm casts with an extended elbow resulted in stiffness; he also recommended open reduction and internal fixation for the posterior Monteggia fracture