Initial management of distal forearm fractures in children

IV: intravenous.

* Moderate or severe pain may be controlled with intranasal or IV fentanyl or IV morphine.

¶ Splint the fracture "as it lies" using either a volar or long arm splint.

Δ Choice of antibiotics depends upon prevalence of methicillin-resistant Staphylococcus aureus in the region. Refer to the UpToDate topics on osteomyelitis in children.

◊ Clinicians who are experienced in pediatric fracture reduction and cast or splint immobilization of the reduced fracture can provide this care for displaced Salter I or II, greenstick, or complete distal forearm fractures in lieu of orthopedic consultation.

§ Nondisplaced isolated radial metaphyseal fractures with up to 15 to 20 degrees angulation can be splinted in a sugar tong splint or casted without reduction in children under 10 years of age with orthopedic follow-up arranged in 3 to 5 days.

¥ The choice of a soft elastic bandage versus a short-arm splint is determined by the parent's/primary caregiver's values and preferences after an informed discussion of treatment options and, regardless of treatment chosen, should include detailed pain management instructions with the expected time of recovery.