Which of the following is the most appropriate initial management for a closed displaced both-bone forearm fracture in a 10-year-old child with >15° angulation?

• A Above-elbow cast without reduction, relying on remodeling
• B Open reduction and plate fixation
• C Elastic stable intramedullary nailing (ESIN)
• D Closed reduction and above-elbow cast under general anaesthesia ✓

Explanation

For displaced both-bone forearm fractures in children, closed reduction under general anaesthesia with an above-elbow cast is the first-line treatment. Children have significant remodeling potential, but >15° angulation in mid-diaphyseal both-bone fractures does not remodel adequately and requires reduction. ESIN is preferred for unstable or failed closed reduction cases, typically in older children (>10 years) or fractures >50% displacement. Open plating is rarely indicated as primary treatment in children.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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