In this section
See also: Radius / ulna shaft (diaphysis) fractures - Emergency Department
Table 1: Recommended follow-up for radial shaft (diaphysis) fractures.
Subsequent review appointments
Discharge advice to parents
Within 7 days post-injury with x-ray in cast
At 2 weeks post-injury with x-ray in cast
At 6 weeks post-injury with removal of cast. X-ray if clinically indicated
If clinical exam normal, discharge
One in twenty shaft fractures will refracture. This occurs primarily in the first 6 months of injury. The risk is higher immediately after cast removal
Contact sports should be avoided for a minimum of six weeks after cast removal. This will be case dependent
Within 7 days post-reduction with x-ray in cast
At 2 weeks post-reduction with x-ray in cast
At 6 weeks post-reduction with removal of cast. X-ray if clinically indicated
Complete (no fixation)
Check for redisplacement and whether the cast is appropriate. After 2-3 weeks, 50% of casts will need to be 'repaired' or replaced.
Once out of plaster, pins are removed at 4-6 weeks post-operatively. The removal of Titanium Elastic Nails (TENS) is made on a case-by-case basis and usually occurs 3- 6 months post-operatively. There is a higher rate of refracture if removed before 3 months.
a) Loss of reduction
d) Forearm stiffness
e) Delayed union or nonunion
i) Muscle entrapment/tendon rupture
j) Complex regional pain syndromes
Indications for a consultant orthopaedic surgeon opinion are:
The indications for discharge are a healed fracture clinically and radiographically with acceptable alignment. Usually occurs at six weeks post-injury and immobilisation.
Bae D. Pediatric distal radius and forearm fractures. J Hand Surgery 2008; 33: 1911-23.
Mehlman CT, Wall EJ. Injuries to the shafts of the radius and ulna. In Rockwood and Wilkins' Fractures in Children, 7th Ed. Beaty JH, Kasser JR (Eds). Lippincott Williams & Wilkins, Philadelphia 2010. p.347-404.
Tredwell SJ, Van Peteghem K, Clough M. Pattern of forearm fractures in children. J Pediat Ortho 1984; 4(5): 604-8.