Fractures of the distal radius and ulna are one of the most common fractures in children. These fractures must be differentiated from their adult counterparts due to vast differences in their management. Most fractures of the distal radius and ulna in children involve the metaphysis or the physis, and most are treated with closed reduction and immobilization. Many younger children don’t even require a closed reduction; for example, in children less than 10 years of age, isolated and overriding fractures of distal radius can be treated with cast immobilization without an attempt at anatomic fracture reduction with satisfactory results. Similarly, physeal fractures of the distal radius in younger children should not be attempted to be reduced after the first 7 to 10 days to prevent physeal injury and resultant growth disturbances; rather they should be allowed to malunite. Radiographic malunion correlates poorly with forearm rotation, and subsequent remodeling should be expected to correct residual deformities. If a closed reduction is required, adequate relaxation and meticulous attention to cast application techniques are necessary. If surgery is indicated, most fractures can be treated with closed reduction and smooth pin fixation. In contrast to distal radius physeal fractures with growth arrest rates of 5 to 7%, similar physeal fractures of distal ulna have a significantly higher growth arrest rate of about 55%. Herman and Pannu provide a comprehensive review of these fractures in children, dividing them based on location and type of fracture and then discussing management principles, including acceptable reduction parameters, nonoperative and operative treatment approaches, and related complications.
There is an apparent increase in pediatric and adolescent sports participation and injuries. A recent study reported on the increasing rate of ACL reconstructions in the skeletally immature over the past 20 years in New York State. There is push from the family and coaches to involve younger and younger children in competitive sports. Such a trend, however, comes with a price. It has long been recognized that there are deleterious physical and psychological effects of competitive sports on the preadolescent child. In 1975, Sayre called attention to the slow and fast maturers, the “drop-out syndrome” in these athletes, and a “ban” on competitive sports involving preadolescent children as a first step toward physical and psychological well-being, that can continue in adulthood. As a physician, it is important to understand the unique skeletal and emotional development in children that differentiates them from an adult. Smucny and colleagues provide a timely review of the short-term and long-term consequences of single-sport specialization in pediatric and adolescent athletes. They provide an overview of the epidemiology of pediatric sports injuries, physiologic and anatomic considerations in young athletes, and tips on assessment of these patients.