4.2 of 74 Ratings
An 11-year old boy presents to fracture clinic 1 week after sustaining a displaced metaphyseal distal radius fracture that was managed with closed reduction and cast application. While the initial post-reduction radiographs showed near anatomic alignment with a well molded cast, radiographs 1 week later show 22 degrees of apex volar angulation and dorsal re-displacement. What is the best management at this time?
Accept the deformity, cast change and follow-up in 3 weeks
Closed reduction and cast application, follow-up in 1 week
Closed reduction and percutaneous fixation
Closed reduction and flexible intramedullary rod fixation
Open reduction and internal fixation with a plate and screws
Select Answer to see Preferred Response
What is the most common fracture in children younger than 16-years-old?
An 8-year-old boy fell while riding his bike and landed on his outstretched arm. Radiographs are provided in Figure A. Which of the following increases the risk of displacement following closed reduction and casting?
Long arm cast immobilization
Short arm cast immobilization
Cast index greater than 0.85
Conscious sedation during reduction
Plaster cast immobilization
You are preparing to cast a child with a both-bone forearm fracture in the emergency room. During cast application, all of the following are directly related to the risk of thermal injury EXCEPT?
Layers of thickness of casting material
Water temperature used to dip casting material
Placing the limb on a pillow during the cast curing process
Fiberglass overwrapping of plaster casts
Type of fracture pattern
Isolated pronation of the forearm will most likely achieve reduction of what type of fracture in a 7-year-old boy?
Supination injury resulting in an apex-volar greenstick both bone forearm fracture
Pronation injury resulting in an apex-dorsal greenstick both bone forearm fracture
Supination injury resulting in an apex-dorsal greenstick both bone forearm fracture
Complete both bone forearm fracture with bayonete apposition of both the radius and ulna
Distal radius fracture with 25 degrees of apex-dorsal angulation
A 4-year-old boy falls while building a tree fort and sustains a closed distal radius fracture. His mother takes him to the teaching hospital and radiographs demonstrate a 15-degree apex volar extra-articular distal radius fracture. The child is neurovascularly intact. He is reduced by the on-call resident and follows up in your clinic two weeks later. You repeat X-Rays which demonstrate 12 degrees of apex volar angulation. The child is freely moving all fingers and has no wrist tenderness. What is the best course of action at this point?
Osteoclasis and pin fixation on your next available operating day
Conscious sedation and repeat reduction of the displaced fracture
Hematoma block and repeat reduction of the displaced fracture
Observation, it should take one year or less for the fracture to remodel
Observation, it should take two years for the fracture to remodel