Management of forearm fracture in children in 2025.

Orthopedic surgeons frequently have to deal with diaphyseal fractures of the two forearm bones. The present update aims to answer five questions: (1) Have the epidemiology and trauma mechanisms of forearm fractures changed over the last two decades? (2) What displacements are acceptable, at what age? (3) Is there any real debate about treatment for diaphyseal fracture of the two forearm bones? (4) What other types of forearm fracture are found in children? (5) What therapeutic strategies should be proposed in the event of complications and sequelae of fracture of the two forearm bones? And how can rates be limited? Fractures of the forearm have increased in incidence over the last 2 decades. Trampolines are greatly implicated. Displacement is acceptable when remodeling is sufficient to restore the anatomical and functional framework of the forearm; non-operative treatment may therefore be proposed up to the age of 10 for <15 ° sagittal displacement and <10 ° frontal displacement with <50% translation. The surgical treatment of choice is elastic stable intramedullary nailing, which may be considered in school-age children. Compartment syndrome is rare, but not exceptional in fracture of both forearm bones in children, particularly in case of crushing, direct impact or numerous reduction maneuvers. To prevent secondary displacement and re-fracture, immobilization may be prolonged, for up to 3 months, with material removal only once the medullary canal is completely permeable. Forearm fractures in children have a very good prognosis. LEVEL OF EVIDENCE >V: Expert opinion.