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Plastic Deformation

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Other Names

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

Background

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

Epidemiology

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

Pathophysiology

  • 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

Evaluation

  • 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

Classification

  • N/A

Management

  • Limited guidance on management[2]

Nonoperative

  • 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

Operative

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

Return to Play

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

Complications

  • Unknown

See Also


References


  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
Authors:
Last edited:
31 October 2020 00:24:51
Categories:
Trauma | Pediatrics | Forearm | Fractures | Acute