#paeds see: [RCH radius and ulna shaft fractures](https://www.rch.org.au/clinicalguide/guideline_index/fractures/Radialulna_shaft_diaphysis_fractures_Emergency_Department/) see also: [[Distal radius or ulna fractures]] >[!key points] >- If there is a fracture of shaft of ulna, evaluate the [[paediatric elbow#Radiocapitellar line (AP and lateral)|radiocapitellar line]] carefully to ==ensure no radial head dislocation== (aka, [[Monteggia fracture-dislocation]] >- If the forearm looks deformed clinically, the fracture will usually need a reduction. If the deformity can only be seen on x-ray, it may need a reduction. >- Post reduction x-rays in the cast must be performed # Acceptable angulations ![[Pasted image 20230826005239.png]] Up to 45 degrees of rotation is acceptable. However, as rotation is very difficult/impossible to quantify on x-rays. Any fracture with demonstrable rotation should be referred for an orthopaedic opinion. # Classification - location -- proximal, midle, distal 1/3 - pattern - plastic defomrmation- bowing without deformity of cortex - greenstick -- incomplete fracture, only convex side of cortex is broken with bending of the bone - complete fracture # Fracture types ## Greenstick ![[Pasted image 20230826010155.png]] ![[Pasted image 20230826010509.png]] refer to acceptable angulations closed reduction and immobilisationin above-elbow cast 6 weeks. three point moulding follow up fracture clinic within 7 days w/ XR ## plastic deformation ![[Pasted image 20230826010239.png]] easy to miss. most common in ulna. refer to ortho for advise ![[Pasted image 20230825230208.png|normal]] ![[Pasted image 20230825230224.png| plastic deformation of the ulna. note the ulna border is not straight.]] eg ![[Monteggia fracture-dislocation#Type I monteggia fracture-dislocation wiht plastic deformation of ulna]] ## complete fracture ![[Pasted image 20230826010308.png]] refer to aceptable angulations. same as greenstick otherwise.