Management of Isolated Radial Diaphyseal Fractures in the Paediatric Population

Introduction Paediatric forearm fractures are common, but isolated radial diaphyseal fractures are rare, representing a small subset. Unlike fractures involving both the radius and ulna, these fractures lack well-established management guidelines. The potential for alignment loss during treatment underscores the need for specific protocols. This study highlights the importance of a tailored approach based on fracture classification. Stable fractures can be managed conservatively, but prompt surgical intervention is critical for unstable cases to prevent malalignment. Methods This retrospective study evaluated 597 paediatric forearm fractures surgically treated between 2011 and 2017. Of these, 49 cases of isolated radial diaphyseal fractures met the inclusion criteria. Patients with distal or proximal epiphyseal/metaphyseal fractures and those older than 18 years were excluded. To guide management, the study developed a simple classification system based on fracture pattern, angulation, and displacement. Results The fractures were classified into three groups based on a simple classification system developed for this study: stable fractures, moderately displaced fractures, and severely displaced or unstable fractures. Stable fractures, characterized by minimal angulation (<10°) and no significant displacement (<2 mm), were managed conservatively with immobilization. All 18 patients in this group achieved union without complications. Moderately displaced fractures, defined as angulation between 10° and 20° or displacement of 2-5 mm, typically required closed reduction, while five cases in this group underwent surgical fixation using elastic stable intramedullary nailing (ESIN). Outcomes for these patients were satisfactory, although some experienced mild complications such as transient stiffness. Severely displaced or unstable fractures, with angulation exceeding 20° or displacement greater than 5 mm, necessitated surgical intervention in all 15 cases. ESIN was the preferred method for stabilization, achieving good alignment and functional recovery, although one patient experienced transient nerve irritation. These results highlight the importance of a tailored approach to management based on the severity of fracture displacement and angulation. Conclusion The proposed classification and treatment protocol standardize management and improve outcomes for paediatric isolated radial diaphyseal fractures. Further research is required to validate these findings and refine treatment strategies for this rare injury.