Paediatric Forearm Fracture

The radius (bone on the thumb side) and ulna (bone 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. Apart from this, the bones in children are prone to a unique injury known as a growth plate fracture. The growth plate, which is made of cartilage (flexible tissue) is present at the ends of the bones in children and helps in the determination of length and shape of the mature bone.

The healing of fractures in children is quicker than that in adults. Thus, if a fracture is suspected in a child, it is necessary to seek immediate medical attention for proper alignment of the bones.

What are the different types of forearm fractures?

Forearm bones may break in many ways. Fractures may be “open” where the bone protrudes through the skin, or “closed” where the broken bone does not pierce the skin.  The common types of fractures in children include:

• A stable fracture that compresses the bone on one side, forming a buckle on the opposite side of the bone, without breaking the bone (Buckle or torus fracture)
• One side of the bone breaks and bends the bone on the other side (Greenstick fracture)
• Displacement of the radius, and dislocation of the ulna at the wrist where both bones meet (Galeazzi fracture)
• Fracture affecting the upper or lower portion of the bone shaft (Metaphyseal fracture)
• Fractured ulna and dislocated head of the radius (Monteggia fracture)
• Fracture occurring at or across the growth plate (Growth plate fracture)

What are the causes of forearm fractures?

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).

What are the symptoms of forearm fractures?

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

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

How are forearm fractures diagnosed?

Forearm fractures in children can be diagnosed by analysing X-ray images of the wrist, elbow or the forearm.

What are the treatment options?

The treatment of forearm fractures in children is based on the location, type of fracture, degree of bone displacement and its severity.

Non-surgical therapy

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 properly without the need for surgery (closed reduction). A splint or cast may be required for 3 to 4 weeks for a stable buckle fracture. Immobilisation for 6 to 10 weeks is recommended for more serious fractures.

Surgical Treatment

Surgery may be necessary for severe fractures such as fractures of the growth plate or the joint. Other conditions, such as broken skin, bone displacement, unstable fractures, misaligned bones, and bones healing in an improper position may also require surgical repair. Your surgeon will first align the bones through an incision and use fixation devices like pins or metal implants to hold the bones in place while the wound heals. A cast or a splint may be placed to hold the bones in place.

Conclusion

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