Imaging Findings

The X-ray of the child’s right forearm shows the following:

• There is a linear discontinuity in the mid-sections of the radius and ulna, suggesting an incomplete fracture, with partial cortical continuity remaining visible.
• The fracture line primarily involves the proximal one-third area of the mid-segment of the radius and ulna. A slight outward angulation of the distal segment is noted, indicating the convexity is on the fracture side.
• No clear fragment displacement or complete fracture through is observed, indicating that the fracture is still in an incomplete state.
• The surrounding soft tissues do not show obvious swelling or abnormal density on imaging.

Potential Diagnoses

Based on the above imaging findings, along with the patient’s age (4 years old) and history of trauma, the following diagnoses are considered:

1. Greenstick fracture
   This type of fracture is common in children due to their bones being less fully calcified and more flexible. It usually affects only one side of the cortex and presents as an incomplete fracture. The mechanism often involves longitudinal or bending forces on the forearm.
2. Torus (buckle) fracture
   This is another common type of incomplete fracture seen in children, often occurring near the junction between the diaphysis and metaphysis due to compressive stress, resulting in a buckle or bulge in the cortex.

Final Diagnosis

Considering the patient’s age, clinical symptoms (history of trauma), and the X-ray findings (single cortical disruption indicating an incomplete fracture), the most likely diagnosis is:

• Greenstick fracture

If any doubt remains or there is a need to further clarify the degree and extent of the fracture, additional clinical follow-up with repeated X-rays or other imaging modalities (such as MRI or CT) may be considered for a comprehensive evaluation.

Treatment Plan and Rehabilitation

Treatment Strategy

• Conservative Treatment:
  • For incomplete fractures with minimal angulation, a cast or splint can be applied for immobilization, typically for 4–6 weeks, depending on the child’s age and rate of bone healing.
  • If there is significant angulation or displacement, closed reduction under anesthesia or sedation may be required prior to casting or bracing.
• Surgical Treatment:
  • If significant angulation or displacement persists after closed reduction, or if there is a high risk of re-fracture, internal fixation may be considered. However, for a 4-year-old patient, surgical indications must be carefully evaluated.

Rehabilitation & Exercise Prescription

During the early stage of fracture healing, the primary goal is proper immobilization and regular follow-up to avoid further injury. General recommendations include:

1. Immobilization Phase (approximately 4–6 weeks)
   • Maintain the integrity of the cast or splint and minimize unnecessary movement of the affected limb.
   • Within the limits set by the physician, gently move the shoulder, elbow, and fingers to prevent joint stiffness and promote circulation.
   • Strength training is not initiated at this stage; focus instead on the child’s comfort and pain management.
2. After Cast Removal (6 weeks and beyond)
   • Once the fracture is largely healed and stable, gradually commence simple active exercises for forearm flexion/extension and pronation/supination.
   • Follow the FITT-VP principle; begin with low intensity and short duration (e.g., 2–3 times per day, 3–5 minutes each session of wrist movements).
   • Increase exercise time and range of motion gradually (e.g., add 1–2 minutes/week per session), while watching for any pain or unusual swelling.
   • After professional evaluation, light resistance exercises using elastic bands or lightweight dumbbells can be introduced, but only within the child’s tolerance to avoid excessive stress on the fracture site.

For children with underlying conditions such as low bone density or other disorders, exercise should be approached with greater caution, and consultation with a specialist or rehabilitation therapist may be necessary.

Disclaimer

This report provides a reference analysis and does not replace an in-person consultation or professional medical advice. If the child’s condition changes or becomes more severe, seek immediate medical attention for tailored diagnosis and treatment recommendations.