Diametaphyseal forearm fracture in childhood. Pitfalls and recommendations for treatment

The optimal treatment for fractures in the diametaphyseal transition zone of the forearm is still a matter of debate. Stable fractures should be immobilized or treated by closed reduction when non-tolerably displaced. Unstable and displaced fractures can be treated by various operative techniques, which are all characterized by technical impracticability or disadvantages for the patient. In younger patients transepiphyseal intramedullary K-wire fixation represents a minimally invasive, quick and technically easy treatment option but requires additional immobilisation. In adolescent patients volar locking plate osteosynthesis constitutes an immobilisation-free treatment option, but is combined with high invasiveness. Percutaneous K-wire fixation and elastic stable intra-medullary nailing may lead to poor results in the diametaphyseal region due to technical or biomechanical problems associated with the implant. The external fixator is indicated in some multifragmentary fractures. The choice of treatment option often results from an individual decision based on the patient's age, complexity and stability of the fracture and interest of the patient. The priority objective of all treatment modalities is a fully functional upper extremity, i.e. full range of motion.