Question
A 10 year old girl has displaced fractures of both radius and ulna in the middle third of the forearm.
- What degree of displacement is acceptable?
- What are your treatment options?
- What are the complications?
Answer
Acceptable alignment
- Remodelling is greatest in younger children and near the distal physis
- Under 10 years, angulation up to about 15 degrees and complete displacement with shortening under 1 cm is often accepted
- Over 10 years, angulation under about 10 degrees
- Rotational deformity does not remodel and limits pronation and supination
Treatment options
- Closed reduction and well moulded above elbow cast, with radiographs at 1 and 2 weeks
- Elastic stable intramedullary nails (titanium elastic nails) for unstable fractures or failed closed treatment
- Plate fixation for older adolescents, open fractures needing debridement or refractures
Complications
- Loss of reduction in plaster
- Malunion with loss of rotation
- Refracture, especially within 6 to 12 months
- Compartment syndrome
- Tendon injury (EPL) and skin irritation from nail ends
- Radioulnar synostosis is rare
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.