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.

1. Case conference
Ext.Setsayabongkorn Ruangsuwan
Phramongkutklao College of Medicine

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

8. Film Left forearm AP, Lateral

9. Probrem List
Closed fracture both bone
left forearm

10. Management
Admit ortho
Observe compartment
syndrome
Pain control

11. Fracture
Forearm Both Bone
in Pediatrics

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

14. Locations

15. Fracture type
• Plastic deformity
• Greenstick fractures
• Complete fractures

16. Presentation
Symptoms
Forearm pain and deformity
Physical exam
Swelling and focal tenderness
Stepping
Neurovascular

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

18. Table of acceptable reduction

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

21. Management
Open reduction and internal fixation
Percutaneous/open reduction and nancy
nailing

22. Complication
Synostosis
Infection
Compartment syndrome
Nonunion
Malunion
Neurovascular injury
Refracture

23. Management
On long arm AP slab
Plan surgery