Pediatric Forearm Fractures

A child’s forearm bones can break in many different ways and in many different locations—near the wrist, elbow, or in between. They are typically caused by a fall on an outstretched arm or when there’s a direct hit to the forearm, injuring one or both bones (ulna and radius).

When a broken bone protrudes through the skin, this is considered an “open” fracture. When it doesn’t, it’s a “closed” fracture.

Common Forearm Fractures

Torus fractures (also known as a stable or buckle fracture) are caused when a bone is compressed on one side, causing the other side to bend away from the growth plate. In this fracture, the bones are still in their position and have not separated apart.
Greenstick fractures occur when one side of the bone breaks and bends the bone on the other side.
Galeazzi fractures effect both the ulna and radius. They are caused when there is a displacement of the radius and the ulna is dislocated at the wrist where both bones meet.
Metaphyseal fracture is across the upper or lower portion of the shaft of the bone and does not affect the growth plate.
Monteggia fractures effect both the ulna and radius. They are caused by a fractured ulna and dislocated head of the radius. This is a severe fracture that requires immediate care.
Growth plate fractures (also known as physeal fractures) are fractures that occur at or across the growth plate. This fracture is typically seen in the growth plate of the radius near the wrist and requires prompt attention.

Signs and Symptoms of Forearm Fractures

Severe pain and numbness
Tenderness and swelling at the site of the injury
Inability to rotate or turn the forearm after injury
Discoloration and bruising around the injury
Snapping and popping at the time of the injury

Making a Diagnosis

Your pediatric orthopedic doctor perform an examination of the arm to determine the injury. They will order X-ray images of your child’s wrist, elbow, or forearm to make an official diagnosis.

Treatment Options

Treatment for forearm fractures will depend on the type of fracture and the degree of the bone displacement. Your doctor may use one or more of the following treatments.

Nonsurgical

For minor forearm fractures, the application of an ice pack over a thin towel on the affected area for 15-20 minutes for three to four times a day should relieve the pain and swelling. For stable buckle fractures, you may simply need to wear a cast or splint for support while it heals. This may take three to four weeks. In the case of severe angled fractures, your child’s pediatric orthopedic doctor will manipulate and align the bones properly back into place, without the need for surgery. This is called closed reduction and the arm is then immobilized with a cast or splint for six to 10 weeks while it heals.

Surgical

The most serious forearm fractures may require surgical repair. During most procedures, a pediatric orthopedic surgeon will align your child’s bones and use pins or metal implants to hold their bones in place while their injury heals. Your child may be then required to wear a cast or a splint during the healing process. Your doctor may recommend surgery if:

The bone has broken through the skin
The fracture is unstable
Bone segments are displaced
The bones can't be aligned properly with manipulation
The bones have begun to heal in an incorrect position

Recovery

The recovery and length of time your splint or cast is worn is dependent on the type and severity of fracture you have. When your cast is removed, your wrist and elbow may be stiff for a few weeks, this stiffness should go away on its own. Allow the bones to slowly regain their strength by working your way to normal activity. If the fracture affects the growth plates at the end of the bone, the bones development may be impacted. In this case, your doctor may recommend multiple follow-up visits for up to a year to make sure the bone growth is proceeding properly.