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Plastic Deformation
From WikiSM
Contents
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
- Fractures
- Pediatric Specific Fractures
- Dislocations & Instability
- Soft Tissue Trauma
- Tendinopathies
- Neuropathies
- Pediatric Considerations
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
- Forearm Pain (Main)
- Elbow Pain (Main)
- Wrist Pain (Main)
- Forearm Anatomy (Main)
- Physical Exam Wrist
- Pediatric Fractures
References
- ↑ 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.
- ↑ 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.