This document summarizes the case of a 13-year-old Thai boy who injured his left forearm after jumping and landing on it. His primary and secondary surveys at the hospital found a deformity and tenderness in his left forearm with x-rays confirming a closed fracture of both forearm bones. His management plan includes admission to orthopedics, monitoring for compartment syndrome, pain control, and potential surgery depending on the healing response and alignment of the fractures. Forearm fractures are common in pediatrics from falls and most can be treated without surgery through casting.
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2. Patient Profile
A 13 Thai boy
Cause of injury : เตะตะกร้อล้ม 1 day PTA
Time : 27 กุมภาพันธ์ 2018
3. Primary survey at MNRH
A Airway patent, able to talk, no cervical
tenderness
B Trachea in midline, symmetrical
movement, equal breath sound breath
sound both lung, CCT negative
C BP 128/76 mmHg, PR 69 bpm
D E4V5M6, pupil 3 mm RTLBE
E Deformity and mark tender at Left
forearm
4. Secondary survey at MNRH
Allergy no drug allergy
Medication no current medication
Past History no underlying disease
Last meal 18.00 27/02/61
Event ผู้ป่วยกระโดดเตะตะกร้อ แขนซ้ายเหยียดยันพื้น ปวดแขนซ้ายทันที มี
แขนซ้ายผิดรูป ไม่มีชา ไม่มีแผลภายนอก ไม่เจ็บศอก ไม่เจ็บข้อมือ ขยับนิ้วมือได้
5. Physical Examination
Vital sign BP 128/76 Pulse 69 bpm RR
20/min
HEENT
No external wound, no
contusion, no tenderness, no
facial deformity
6. Physical Examination
Chest
No contusion, trachea in midline
symmetrical movement, clear &
equal breath sound both lung,
normal S1 S2 no murmur
Abdomen
No distendsion, normoactive BS,
soft, not tender, no guarding
7. Physical Examination
Perineum
No seen external wound
Neurologic
E4V5M6, pupil 3 mm RTLBE,
power at gr 5 all extremities except
Lt arm cant be evaluated due to
pain, sensory intact
12. Mechanism of Injury
One of most common in
pediatrics fracture
Fall on an outstreched hand that
transmits indirect force to the
bones of the forearm
17. Management
Non- operative ; closed reduction and
immobilization
Indications
Most pediatric forearm fractures can
be treated without surgery
Greenstick injuries
Bayonet apposition < 1 cm if < 10 years
19. Management
Casting
Long arm cast/slap 4-6 wks,
possible conversion to short arm
cast after 4 wk (depending on
fracture type and healing
response)
F/U in 1st wk; ดูเฝือก
F/U every 2 wk; พิจารณาถอดเฝือกเมื่อกระดูก
เชื่อมติดกันดี
20. Management
Operation
Indication
Unacceptable alignment following closed reduction
Angulation > 15°, rotation >45° in children <10 y
Angalation > 10°, rotation >30° in children >10 y
Bayonet apposition in children older than 10 years
Both bone forearm fractures in children >13
