fractures are typically seen in the setting of ipsilateral radial metaphyseal fracture; inability to achieve similar reduction in both bones is highly predictive of redisplacement Clinical Considerations Clinical Recognition Children with distal radius and ulna fractures will typically present with focal arm pain, swelling, or deformity It should be noted that wrist pain may also be the chief complaint with more proximal injuries, for example, radial head fractures Triage Considerations These children may present with obvious deformity and significant pain or with minimal deformity and mild pain Patients with plastic deformities, greenstick, and torus fractures may present several days after the injury The injured extremity should be immobilized and pain management addressed Clinical Assessment Localized swelling and tenderness commonly accompany distal radial fractures and can guide interpretation of the radiographic studies Management Radiographs that include the entire forearm, including the elbow and wrist, should be obtained to identify all possible injuries to the extremity Several common fracture patterns exist in injuries of the distal radius and ulna, and management varies by diagnosis ( Fig 111.30 ) Some cases may be managed with only gentle manipulation without sedation or through the use of local anesthetics or blocks, eliminating the potential risks and costs associated with sedation Torus fracture With torus fractures, often the location of the soft tissue swelling on the radiographs helps highlight the position of the fracture These fractures may be subtle, evident on only one projection and then only as a minor irregularity in the contour of the cortex When a torus fracture is identified, a short arm volar splint or, if the swelling is minimal, a short arm cast for to weeks is recommended A removable splint for to weeks has been shown to be as effective as casting, with the additional advantage of interfering less with physical functioning and activities Follow-up may occur with the primary care clinician or with the orthopedic surgeon, and serial radiographs to guide management are infrequently needed