Plating is the standard technique for treating forearm fractures in adults and is therefore best considered for skeletally mature or nearly mature children.
Children with open physes have thick active periosteum favoring stability and rapid healing with the ESIN method. Where such techniques are unavailable plating may be used in younger children.
If technically possible, ESIN is biologically favored. If plating is used, soft-tissue and periosteal stripping of the bone should be minimized.
Plating of pediatric forearm shaft fractures follows the technique for plate fixation in adults.
Both bones need to be fixed according to their fracture pattern.
Order of reduction and fixation
The order of fixation is a matter of surgeon preference.
Combination with other treatment options
Plating one bone can be combined with ESIN or external fixation of the other bone where clinically indicated.
This may be useful in open fractures, with unstable segmental fractures, or in situations where closed reduction cannot be obtained.
Choice of approach
The bones should be approached through separate incisions to prevent cross-union.
For proximal radial shaft fractures, the anterior approach (Henry) is most often used to minimize the risk of damage to the posterior interosseous nerve, which crosses the proximal radius within the supinator.
Check the completed osteosynthesis with image intensification. These images should be retained for documentation or alternatively an x-ray should be obtained before discharge.
Make sure that the plate is at the correct location, the screws are of appropriate length and the desired reduction has been achieved.
Stabilize the elbow at the epicondyles and check the forearm rotation.
7. Aftercare following plating
Immediate postoperative care
Whilst the child remains in bed, the forearm should be elevated on pillows to reduce swelling and pain.
Casting or Splinting
Plate fixation of forearm fractures is intrinsically stable and supplementary casting or splinting is therefore not required.
Some surgeons prefer a long or short splint for 2-3 weeks postoperatively for comfort.
Ibuprofen and paracetamol should be administered regularly during the first 4-5 days of injury, with additional oral narcotic medication for breakthrough pain.
If the level of pain is increasing the child should be examined.
The child should be examined regularly, to ensure finger range of motion is comfortable and adequate.
Neurological and vascular examination should also be performed.
Compartment syndrome should be considered in the presence of increasing pain, especially pain on passive stretching of muscles, decreasing range of active finger motion or deteriorating neurovascular signs, which are a late phenomenon.