Surgical management of forearm and distal radius fractures in children and adolescents.

Closed reduction with cast immobilization is the preferred method of treatment for most fractures of the forearm and distal radius in children and adolescents. Nonunion of these fractures is exceptionally rare, and remodeling restores alignment for minor incomplete reductions. Most closed reductions can be performed in the emergency department with the patient sedated or with regional anesthesia. However, reduction in an operating room with the patient under general anesthesia lowers the threshold for surgical stabilization to avoid the need for repeat reductions under general anesthesia. Surgical management with fixation is often indicated for unstable fractures, open fractures, refractures, and in circumstances involving multiple trauma and other complex injuries.