Purpose: To determine the need for routine serial radiographs in the management of forearm fractures in children.

Material and Methods: A binational study was conducted in 202 consecutive children with closed forearm fractures. In the 91 patients with stable fractures that did not require reduction, clinical and radiographic examination was performed one week after the start of treatment and again on cast removal 4–6 weeks later. In the remaining 111 patients who underwent closed reduction, an additional X-ray was taken two weeks after cast placement. Outcome was defined as the occurrence of redisplacement.

Results: Redisplacement occurred during the first 2 weeks of cast management in 9 of the children who required reduction and in none of the children who did not.

Conclusion: Radiographs should be performed one week after cast placement for greenstick or complete fractures that do not require reduction, and repeated at 2 weeks from start of treatment for fractures that require reduction. They need not be performed on cast removal, if clinical examination does not show signs of nonunion or malalignment. The adoption of these recommendations will lead to more cost-effective management and will spare children unnecessary radiographic exposure.

Redisplacement of unstable forearm fractures in plaster is common and may be the result of a number of factors. Little attention has been paid to the influence of immobilisation with the elbow extended versus flexed. We prospectively treated 111 consecutive children from two centres with closed forearm fractures by closed reduction and casting with the elbow either extended (60) in China or flexed (51) in Israel. We compared the outcome of the two groups. There was no statistically significant difference in the distribution of the age of the patients, the site of fracture or the amount of angulation and displacement between the groups. During the first two weeks after reduction, redisplacement occurred in no child immobilised with the elbow extended and nine of 51 children (17.6%) immobilised with the elbow flexed. Immobilisation of unstable forearm fractures with the elbow extended appears to be a safe and effective method of maintaining reduction.