In this section
Distal radius and / or ulna metaphyseal fractures - Emergency Department
Table 1: Recommended follow-up schedule for distal radius and/or ulna metaphyseal fractures.
Subsequent review appointments
Discharge advice to parents
Complete - undisplaced or minimally displaced
Within 7 days post-immobilisation with x-ray
At 6 weeks post-immobilisation. Removal of cast and x-ray out of cast
If x-ray findings satisfactory and clinical exam normal, discharge
Gradual return to sports 4-6 weeks post-removal of cast
Complete - displaced fractures
Within 7 days post-reduction with x-ray
At 2 weeks post-reduction with x-ray
At 6 weeks post-reduction. Removal of cast and x-ray out of cast. If x-ray findings satisfactory and clinical exam normal, discharge
Complete fractures of both radius and ulna have higher risk of loss of reduction and need to be carefully observed. Older children (with less than 2 years growth remaining) may need further follow-up due to less remodelling potential
2-3 months for return to full contact sports
Check for redisplacement and whether the cast is appropriate. Assess neurovascular status and document findings.
Loss of reduction and malunion are the most common complications:
Nonunion or physeal injury is rare.
Indications for an orthopaedic consultant review are:
The indications for discharge are a healed fracture clinically (i.e. pain free on movement and non-tenderness at the fracture site) and radiographically, with acceptable alignment. This usually occurs at 6 weeks post-reduction and immobilisation.
Waters PM, Bae DS. Fractures of the distal radius and ulna. In Rockwood and Wilkins' Fractures in Children, 7th Ed. Beaty JH, Kasser JR (Eds). Lippincott Williams & Wilkins, Philadelphia 2010. p.292-346.