Overview
- Common childhood fracture from falls on the outstretched hand
- Greenstick and complete patterns, with buckle injuries treated separately
- Remodelling is better in younger children and in the distal third
- Remodelling does not correct rotation
Assessment
- Check skin for open injury, neurovascular status and signs of compartment syndrome
- Examine the elbow and wrist for Monteggia and Galeazzi injuries
- Full length AP and lateral forearm radiographs including both joints
Acceptable Alignment
- Noonan and Price accept up to 15 degrees of angulation and 45 degrees of malrotation under 9 years
- From 9 years accept up to 10 degrees of angulation and 30 degrees of malrotation
- Aim for less in the proximal third and in older children
Management
- Closed reduction under sedation or anaesthesia with a moulded long arm cast, with a straight ulnar border and interosseous mould
- Review radiographs weekly for 2 to 3 weeks because redisplacement is common
- Cast for 6 to 8 weeks depending on age and healing
- Surgery is indicated for open fractures, failed or lost reduction, floating elbow and neurovascular compromise, and is more often needed in older children
- Flexible intramedullary nails in the radius and ulna are the usual surgical option
- Plating suits older children near skeletal maturity or unstable patterns
Complications
- Malunion with loss of forearm rotation
- Refracture after union
- Compartment syndrome
- Nerve injury and synostosis
- Nail prominence and extensor pollicis longus rupture with radial nail entry
Written by Western Health Orthopaedic Department
Last updated October 2026
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 15 October 2026.