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Orthogate
1089 Spadina Road
Toronto, AL M5N 2M7
Ph: 416-483-2654
Fax: 416-483-2654
christian@orthogate.com






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I need some quick information. We are at the point of deciding whether or not surgery should be done for our 10-year-old. He fell while dinking around with some friends and broke his forearm. The surgeon says he hasn't completed full bone growth so there's a chance he could heal okay without surgery. I would opt for that but my wife wants him to have the surgery for cosmetic reasons (she's afraid he'll end up with a crooked arm). What do you advise?

Your surgeon is really the best one to give you all the information you need for a decision like this. But we may be able to offer some things to consider when talking with him or her. As you have probably seen from the X-rays, the forearm has two bones (radius and ulna). Fractures of one or even both of these bones are among the most common childhood fractures. Most of the time these types of breaks are clean and simple. The physician can line the bones back up without surgery. The child wears a splint or cast for four to six weeks while the bone remodels and heals. And quite honestly, if the child has not yet completed his or her full growth and has not yet reached skeletal maturity, the bone does a remarkable job healing and even restoring normal anatomy. There are problematic forearm fractures that require recognition and special treatment. In the simplest of cases, the bones are displaced (separated). There may be a hidden dislocation along with the fracture that doesn't show up on a plain X-ray. Or there could be a fracture with bone rotation so the ends no longer line up as they should. Putting the arm in a cast without realigning the bones could result in permanent loss of wrist and forearm motion. Sometimes one or both of the bones break and leave the bone at an angle. This type of deformity won't realign on its own. To add to that list, there could be cases where the forearm fracture affects the alignment of the elbow. The surgeon will make every effort to identify the type of fracture and any other associated soft tissue or joint injury. It is especially important to look for damage to the ligaments, blood vessels, and/or nerves. Complete diagnosis may require additional imaging using computed tomography scans (CTs) or magnetic resonance imaging (MRI). The child's age makes a big difference in planning treatment. Children up to age eight will have the capacity to heal, repair, and remodel angular deformities of the bones up to 15 degrees. X-rays will help determine the skeletal age of maturity and show how much more growth is left. If the child is within a year or two of full skeletal maturity, then he or she should be treated as an adult. Closed reduction (realignment without surgery) is acceptable for many of the younger children. But open reduction with internal fixation (ORIF) is often required when there are unusual circumstances or complications. A flexible titanium rod may be placed down through the length of the fractured bone. Metal plates and/or stainless steel pins may be used until union occurs. Most surgeons will advise minimal surgical intervention if it is clear surgical correction is not required. Surgeons treating children with forearm fractures are vigilant in watching for complications that can leave the child with permanent deformities or loss of motion. Careful evaluation at the time of the injury AND close observation during healing, recovery, and follow-up are essential to recognize fractures that may need corrective surgery. Elbow joint instability (due to ligamentous damage or dislocation), malunion, and excess bone angulation require special surgical management.

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