Management of Diaphyseal Forearm Fractures in Adolescents

Inclusion criteria

• Age: 10 to 16 years (at time of injury).
• Fracture pattern: diaphyseal fracture involving both the radius or ulna.

o Fracture location: Diaphysis defined as the segment between the proximal metaphyseal flare (distal to bicipital tuberosity for radius; distal to coronoid process for ulna) and the distal metaphyseal flare (within 3 cm of the distal physis).

• Indication for surgery: Failure of closed reduction or unacceptable alignment after attempted closed reduction, defined as:

• Angulation > 15° in any plane (sagittal or frontal).
• Translation > 50% of bone diameter.
• Bayonet apposition.
• Open fracture (Gustilo type I).
• Inability to maintain acceptable reduction after cast immobilization (loss of reduction).
• Skeletal maturity: Open or partially open distal radial physis (assessed on preoperative radiographs).

Exclusion criteria

• Open fracture Gustilo type II & III.
• Pathological fracture (secondary to bone cyst, tumor, osteogenesis imperfecta, etc.).
• Neurovascular compromise requiring emergent exploration (e.g., acute compartment syndrome, pulseless limb after reduction).
• Floating elbow (ipsilateral supracondylar humerus fracture + forearm fracture).
• Monteggia or Galeazzi fracture-dislocation patterns
• Metabolic bone disease (e.g., rickets, osteomalacia, renal osteodystrophy).
• Neuromuscular disorder affecting upper extremity function (e.g., cerebral palsy, muscular dystrophy, brachial plexus injury).
• Active infection at surgical site or systemic infection.