#paeds see also: [[Radius and ulna shaft fractures]], [[Barton fracture]], [[Smith fracture]], [[colles fracture]] see: [RCH distal radius or ulna fractures](https://www.rch.org.au/clinicalguide/guideline_index/fractures/Distal_radius_and_or_ulna_metaphyseal_fractures_Emergency_Department_setting/) # normal findings ![[Pasted image 20240322211133.png| normal lateral view of wrist. astrisk is triquetrum. note the normal alignment of the pronator quadratus fat stripe paralleling the volar cortex of the distal radus.]] # acceptable angulations 0-5 years <20 degrees ![[Pasted image 20230826012702.png]] 5-10 years <15 degrees ![[Pasted image 20230826012755.png]] 10-15 years - <10 degrees ![[Pasted image 20230826012814.png]] Bayonet apposition is acceptable in children up to age of six as long as angulation alignment parameters are acceptable. For children aged 6-10 years, if the fracture is still in bayonet position after reduction, ask the orthopaedic on call service to review the post-reduction x-rays to check if the position is acceptable. Children aged 11 years and above need to have apposition at the fracture site. ![[Pasted image 20230826012859.png]] # Management of specific fractures ## Buckle fracture ![[Pasted image 20230826012955.png]] ![[Pasted image 20230826013240.png]] ![[Pasted image 20230826013254.png]] - no reduction required - below elbow plaster or removable wrist splint for 3 weeks ## complete undisplaced or minimally displaced fracture - refer to acceptable angulations - plaster 6 weeks below elbow ## complete displaced fracture - closed reduction - below elbow >6 years old; above elbow for young children ![[Pasted image 20230826013322.png]] ![[Pasted image 20230826013327.png]] # Colles' fracture # smith fracture - reverse colles' # barton fracture - like a smith but also dislocation of radiocarpal jjoint