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Let’s play! Forearm fractures
Case presentation
A 4-year-old child presents after falling on an outstretched hand while running at school. He complains of pain to the right forearm and is splinted by the school nurse and given pain medicine by paramedics. There is no open abrasion or puncture to the skin. His vital signs are all age appropriate. There does not appear to be any injury to the head, neck, back, shoulder, upper arm, or wrist. He is grossly neurovascularly intact.
Imaging considerations
Most forearm fractures result from a fall onto an outstretched hand, and immediate pain control is key to completing a thorough examination as well as obtaining adequate radiographs. Intranasal fentanyl (2 mcg/kg, maximum single-dose 100 mcg) delivered via a mucosal atomizer device can achieve pain control within 10 minutes while radiographs and intravenous access are obtained.
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