- [Home](https://ortopediaevolutiva.com/en) - [Pediatric Orthopaedics Blog — Dr. Priano](https://ortopediaevolutiva.com/en/blog) - Diaphyseal fractures of the radius and ulna in children: cast, TEN/ESIN, and reduction stability # Diaphyseal fractures of the radius and ulna in children: cast, TEN/ESIN, and reduction stability March 30, 2026 3 min read Edited and medically reviewed by [Dr. Daniele Priano](https://ortopediaevolutiva.com/en/about) ![Diaphyseal fractures of the radius and ulna in children: cast, TEN/ESIN, and reduction stability](https://qoxwtbnwsrbatawnkgst.supabase.co/storage/v1/object/public/blog-images/blog/fratture-diafisarie-radio-ulna-bambino-gesso-ten.jpg) This English version is based on the original Italian article. For wording nuances, you can refer to the Italian version. ## In short, for parents - • Casting and TEN/ESIN can both give good results for forearm shaft fractures when appropriate for the individual case. - • Loss of fracture alignment can occur during healing; fixation may reduce this risk in selected cases but carries surgical risks. - • Age, remaining growth and stability guide treatment; a cast after TEN depends on the individual indication. Diaphyseal fractures of the radius and ulna in children can be treated with reduction and casting or, in selected cases, with internal fixation using TEN/ESIN. Both strategies generally lead to healing and good functional outcomes; what differs most is the stability of the treatment course. [1–4] A meta-analysis published in 2025 in JPOSNA included 24 studies and 1,157 patients with diaphyseal fractures of both forearm bones. Healing was 100% in both the surgical and conservative groups. [1] ## Stability and Redisplacement In the conservatively treated group, overall complications were more frequent: 24% versus 12%. Redisplacement was reported in 26% of cases treated with a cast and 3% of those who underwent surgery; additional procedures were also more common in the conservative group. [1] This does not mean that casting is an absolutely inferior treatment. In young children, with a stable [fracture](https://ortopediaevolutiva.com/en/conditions/injuries-fractures) and good remodeling potential, it often remains the most proportionate choice. The main limitation is the possibility that an initially acceptable reduction may progressively lose alignment. ## What TEN/ESIN Offers Elastic stable intramedullary nailing (ESIN) stabilizes the fracture and reduces reliance on maintaining reduction within the cast. In older children, adolescents, and unstable fractures, this can simplify follow-up and reduce the risk of needing further treatment. [1,4] A prospective randomized trial from 2025 compared children treated with ESIN with or without postoperative immobilization. In the non-cast group, the callus score was better at early follow-ups and quality of life at 6 weeks was superior, without an increase in complications in the studied sample. [2] A retrospective series of 173 patients treated with ESIN without postoperative casting reported complete healing and a low rate of major complications. [3] These data do not prove that casting after TEN is useless in every situation, but they show that stable fixation can allow for more flexible postoperative management. ## The Choice Depends on Fracture Type and Age In young children, a well-reduced and stable fracture can be treated very effectively with a cast. As age increases, the remodeling potential decreases, and a loss of reduction or residual malrotation becomes less tolerable. TEN/ESIN therefore gains more importance when the fracture is unstable, when reduction tends not to be maintained, or when age makes spontaneous remodeling less reliable. ## Immobilization and Daily Life Part of the benefit of internal fixation is not visible on the final X-ray alone. Reducing or avoiding a postoperative cast can mean less stiffness, simpler hygiene, and an easier recovery in the first few weeks. However, this benefit must be weighed against anesthesia, surgical wounds, possible problems with the nails, and a subsequent hardware removal. For diaphyseal fractures of the radius and ulna, the useful question is not which technique "heals all fractures better." It is about understanding in which cases casting offers sufficient stability and in which cases internal fixation avoids a more uncertain course. Disclaimer This content is for informational purposes only and does not replace individual clinical evaluation. Riferimenti [1] Sharma O, Hamidi D, Bozzo I, Alrajhi K, Bernstein M. Surgical and Conservative Management are Both Effective for Pediatric Both Bone Forearm Fractures: A Systematic Review and Meta-Analysis. J Pediatr Soc North Am. 2025;13:100267. doi:10.1016/j.jposna.2025.100267. PMID: 41126900. PubMed: [https://pubmed.ncbi.nlm.nih.gov/41126900/](https://pubmed.ncbi.nlm.nih.gov/41126900/) [2] Herdea A, Dragomirescu MC, Tiron M, Ulici A. Forearm fractures treated with elastic stable intramedullary nailing: Is casting still necessary? J Child Orthop. 2025;19(4):276-283. doi:10.1177/18632521251352323. PMID: 40692964. PubMed: [https://pubmed.ncbi.nlm.nih.gov/40692964/](https://pubmed.ncbi.nlm.nih.gov/40692964/) [3] Pogorelić Z, Gulin M, Jukić M, Nevešćanin Biliškov A, Furlan D. Elastic stable intramedullary nailing for treatment of pediatric forearm fractures: A 15-year single centre retrospective study of 173 cases. Acta Orthop Traumatol Turc. 2020;54(4):378-384. doi:10.5152/j.aott.2020.19128. PMID: 32442119. PubMed: [https://pubmed.ncbi.nlm.nih.gov/32442119/](https://pubmed.ncbi.nlm.nih.gov/32442119/) [4] Reddy E, Sriwastwa A, Patel S, Gupta R, Parikh SN. Elastic stable intramedullary nailing for pediatric forearm fractures: A review article. J Clin Orthop Trauma. 2025;71:103249. doi:10.1016/j.jcot.2025.103249. PMID: 41245351. PubMed: [https://pubmed.ncbi.nlm.nih.gov/41245351/](https://pubmed.ncbi.nlm.nih.gov/41245351/) ## Complete injuries and fractures pathway This page is part of the paediatric injuries and fractures pathway. The main guide covers the overall picture and the warning signs. - [1 Overview: when an injury is urgent How growing bone behaves, what happens in the emergency room and when an orthopaedic review is useful.](https://ortopediaevolutiva.com/en/conditions/injuries-fractures) - [3 Elbow and forearm Supracondylar, forearm and wrist fractures: the most frequent paediatric sites.](https://ortopediaevolutiva.com/en/conditions/elbow-fracture-children) [Forearm](https://ortopediaevolutiva.com/en/conditions/forearm-fracture-children) - [Wrist](https://ortopediaevolutiva.com/en/conditions/wrist-fracture-children) - [Elbow surgery](https://ortopediaevolutiva.com/en/surgery/fractures/elbow) - [Forearm surgery](https://ortopediaevolutiva.com/en/surgery/fractures/forearm) - [Wrist surgery](https://ortopediaevolutiva.com/en/surgery/fractures/wrist) - [4 Hand and fingers: recovery after immobilisation Recovery sheet for finger motion after a splint or cast, with the stiffness signs to report.](https://ortopediaevolutiva.com/en/parents-kids/exercises/post-cast/after-finger-cast) - [5 Lower limb and ankle Femur, leg, knee and ankle: weight-bearing, healing times and return to walking.](https://ortopediaevolutiva.com/en/conditions/femur-fracture-children) ![Dott. Daniele Priano](https://ortopediaevolutiva.com/assets/doctor-avatar-3d-CTvqnoPa.webp) ### Concerned about your child? If you recognize any of these signs in your child, a specialist assessment can give you clarity. I see children at Gaetano Pini and CTO institutes in Milan. 5.0 · Google & MioDottore [Book a private visit](https://ortopediaevolutiva.com/en/locations#prenota) ### Related Conditions [Fractures and trauma](https://ortopediaevolutiva.com/en/conditions/injuries-fractures) ### Related Surgery Pages [Fracture treatment](https://ortopediaevolutiva.com/en/surgery/injuries-fractures) ### Related Articles [Kirschner Wire Infection in Children: When Can It Become Osteomyelitis? Read](https://ortopediaevolutiva.com/en/blog/kirschner-wire-infection-children-osteomyelitis-risk)[Proximal humerus fracture in children: when is surgery really needed? Read](https://ortopediaevolutiva.com/en/blog/proximal-humerus-fracture-children-when-surgery-is-needed)[Growth plate fractures: why does follow-up continue after the bone has healed? Read](https://ortopediaevolutiva.com/en/blog/growth-plate-fractures-follow-up-after-healing) ![Dott. Daniele Priano](https://ortopediaevolutiva.com/assets/doctor-avatar-3d-BiLSxBxW.webp) Author and medical reviewer ## Dr. Daniele Priano [Pediatric orthopaedic care in Milan](https://ortopediaevolutiva.com/en) — Gaetano Pini & CTO [Read full bio](https://ortopediaevolutiva.com/en/about) --- Canonical: https://ortopediaevolutiva.com/en/blog/pediatric-forearm-shaft-fractures-cast-or-ten Le informazioni cliniche sono divulgative e non sostituiscono una valutazione medica diretta.