# Intra-operative Technique for Managing Paediatric Distal Forearm Fractures

## TL;DR

A new surgical technique is proposed for treating forearm fractures in children, aiming to reduce complications by using a minimally invasive approach.

## Contribution

The paper introduces a novel intra-operative reduction technique for paediatric distal forearm fractures that minimizes soft tissue disruption and manipulation force.

## Key findings

- A minimally invasive approach with small incision allows precise haematoma evacuation and gentle fracture reduction.
- The technique uses a McDonald’s elevator and K-wires for stable fixation under image intensifier guidance.
- The method offers reduced manipulation force and potential for fewer iatrogenic complications.

## Abstract

Paediatric distal forearm fractures are a common injury in children and adolescents, often requiring surgical intervention. Traditional techniques involve forceful manipulation and hyper-exaggerating the defect to overcome haematoma resistance, increasing the risk of complications including iatrogenic displacement, neurovascular injury, and growth plate damage. This technical note describes an alternative intra-operative reduction technique aimed at addressing these limitations.

A minimally invasive approach with a small incision allows for precise identification and gentle evacuation of the haematoma. Under image intensifier guidance, fracture fragments are carefully reduced with the use of McDonald’s elevator, utilising gentle levering and manipulation. Kirschner wires (K-wires) are then inserted percutaneously for stable fixation.

This technique offers potential technical advantages, including reduced manipulation force and minimised soft tissue disruption. Whilst formal outcome assessment is beyond the scope of this report, this approach represents a reproducible alternative for the intra-operative management of paediatric distal forearm fractures.