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Plastic Deformation

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Other Names

  • Bowing Fracture
  • Plastic Bowing Fracture
  • Plastic Fracture
  • Bowing Deformity


  • Incomplete fractures of tubular long bones in pediatric patients, most commonly Radius and Ulna
    • Can also occur in Fibula and any other long bone


  • Universally occur in children due to plasticity of long bones[1]
  • Case reports in adults


  • Pediatric bones have increased elasticity, enabling to bend significantly under stress or trauma
  • Low forces will allow the bone to return to normal position
  • If force exceeds mechanical strength of bone, plastic deformation is the result
  • Radiographs do not show cortical break, however

Associated Injuries

Risk Factors

  • Unknown

Differential Diagnosis

Clinical Features

  • General: Clinical Exam Forearm
  • History
    • Some form of trauma, typically a fall
  • Physical
    • Pain, swelling, bruising at area of injury
    • Deformity if bowing is significant
    • Painful pronation, supination


  • Radiographs
    • AP and Lateral Forearm as screening radiographs
    • Bowing will be seen in plane perpendicular to plane of bowing
    • In parallel plane, bowing may not be seen
    • No fracture line or cortical insult
    • There may be co-occuring injury to paired bone


  • N/A


  • Limited guidance on management[2]


  • Isolated plastic deformity fractures can typically be managed nonoperatively
  • Contention about need for reduction
  • One approach is:
    • < 20° angulation, closed reduction not necessary
    • > 20° angulation, closed reduction required
    • Age > 10 reduction is required due reduced potential for remodeling
  • Acute: Sugar Tong Splint
  • Follow up/ Subacute: Short Arm Cast or Prefab splint


  • If co-occurring injury to paired bone, surgical intervention likely

Return to Play

  • Variable
  • Isolated injuries recovery quickly
  • At discretion of managing physician


  • Unknown

See Also


  1. BORDEN IV, S. P. E. N. C. E. R. "Roentgen recognition of acute plastic bowing of the forearm in children." American Journal of Roentgenology 125.3 (1975): 524-530.
  2. Vorlat, Peter, and Hugo De Boeck. "Bowing fractures of the forearm in children: a long-term followup." Clinical Orthopaedics and Related Research (1976-2007) 413 (2003): 233-237.
Created by:
John Kiel on 30 June 2019 19:51:54
Last edited:
31 October 2020 00:24:51
Trauma | Pediatrics | Forearm | Fractures | Acute