Forearm Fractures in Children

The radius (on the thumb side) and ulna (on the little-finger side) are the two bones of the forearm. Forearm fractures can occur near the wrist, near the elbow or in the middle of the forearm.

Fractured bones heal faster in children when compared to adults. However, a fracture or injury to the growth plate can disrupt the growth phase and lead to deformity if not addressed immediately. The growth plate, present at the ends of long bones in children, is made of cartilage (flexible tissue), which eventually grows into mature adult bone tissue.

Forearm bones may break in many ways.

• Fractures may be “open”, where the broken bone protrudes through the skin. This type of fracture is highly prone to infection.
• Buckle or torus fracture: This is a stable fracture that compresses the bone on one side, forming a buckle on the opposite side of the bone, without breaking the bone.
• Greenstick fracture: One side of the bone breaks and bends the bone on the other side.
• Galeazzi fracture: This involves the displacement of the radius, and dislocation of the ulna at the wrist where both bones meet.
• Metaphyseal fracture: The fracture affects the upper or lower portion of the bone shaft.
• Monteggia fracture: This is a serious injury where the ulna is fractured and radius head dislocated, requiring immediate care.

Forearm fractures in children are caused due to a fall on an outstretched arm or direct hit on the forearm, which may result in breakage of one or both bones (radius and ulna).

A fractured forearm causes severe pain. Other signs and symptoms include:

• Swelling
• Tenderness
• Inability to turn or rotate the forearm
• Deformed appearance to the forearm, wrist or elbow
• Bruising or discoloration of the skin
• Popping or snapping sound during the injury

Forearm fractures in children can be diagnosed by a thorough examination of the arm and analyzing X-ray images of the wrist, elbow and forearm.

The treatment of forearm fractures in children is based on the location, type of fracture, degree of bone displacement and its severity. A single treatment or combination of treatments may be suggested to efficiently treat the forearm fracture.

Your child’s doctor will advise you to apply an ice pack over a thin towel on the affected area for 15-20 minutes 3-4 times a day, to relieve pain and swelling. For severe angled fractures, in which the bones have not broken through the skin, your doctor will align the bones through manipulation without the need for surgery (closed reduction). A splint or cast may be required for 3 to 4 weeks. Immobilization for 6 to 10 weeks is recommended for more serious fractures.

Surgery is usually indicated for fractures of the growth plate, joint fractures, open fractures, displaced bones, unstable fractures, misaligned bones and bones healing in an improper position. Your surgeon will make a cut on the skin to access the fracture and align the bones (open reduction).This is then supported by fixation devices such as pins or metal implants that hold the bones in place while the wound heals (internal fixation). A cast or a splint may be placed until the bones heal.

Your child’s forearm may have a slightly different or crooked appearance than before the fracture, which is normal. It may take around 1-2 years for the bones of the forearm to straighten out while the bones undergo a process of remodeling (reshaping). For growth plate fractures, your child’s doctor will carefully monitor the hand for many years to ensure that growth occurs normally.