Introduction
Forearm fractures are one of the most common fractures seen in children and accounts for around 50 percent of all pediatric fractures treated.
Your forearm is the section of the arm between the elbow and the wrist. It is made up of 2 bones called the radius and the ulna. The radius is the bone located on the thumb side of the forearm and the ulna is the bone located on the little finger side of the forearm.
The primary function of your forearm is rotation, including the ability to turn your palm up and down. A fracture of the forearm affects the ability to rotate your arm, as well as bend and straighten the wrist and elbow. Forearm fractures can occur near the wrist, near the elbow, or in the middle of the forearm. However, about 3 out of 4 forearm fractures in children occur at the wrist end of the radius. Apart from this, the bones in children are prone to a unique injury known as a growth plate fracture. The growth plate is a flexible cartilage tissue present at the ends of the bones in children and helps determine the length and shape of the mature bone.
Types of Forearm Fractures
Forearm bones may break in various ways depending on the injury. 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:
- Buckle or torus fracture: 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 displacement of the radius and dislocation of the ulna at the wrist where both bones meet.
- Metaphyseal fracture: This is a fracture affecting the upper or lower portion of the bone shaft.
- Monteggia fracture: This involves a fractured ulna and dislocated head of the radius from the elbow joint.
- Growth plate fracture: This is a fracture occurring at or across the growth plate. These fractures are especially common near the wrist.
Causes
Forearm fractures are quite common in active children as they play and participate in sports activities. In most cases, forearm fractures in children are caused due to a fall on an outstretched arm, a fall directly on the forearm, or a direct blow to the forearm, which may result in the breakage of one or both bones (radius and ulna).
Signs and Symptoms
Some of the common signs and symptoms of a forearm fracture in children include:
- Swelling
- Tenderness
- Pain
- Numbness and tingling
- Inability to turn or rotate the forearm
- Deformed forearm, wrist, or elbow
- Bruising or discoloration of the skin
- Popping or snapping sound during the injury
Diagnosis
In order to diagnose a pediatric forearm fracture, your physician will review your child’s medical history and conduct a physical examination of the forearm to elicit pain and other associated symptoms. Your physician will also examine your child’s hands and fingers to make sure that the nerves and circulation have not been affected as a result of the fracture. Your physician will then order x-rays of the forearm, elbow, and wrist to confirm the diagnosis and determine the type and severity of the fracture.
Treatment
Most cases of forearm fractures in children can be treated without surgery. The treatment usually depends upon the location of the fracture, type of fracture, degree of bone displacement, and its severity.
Nonsurgical Treatment
- Icing: Your child’s doctor will advise you to apply an ice pack over a towel on the affected area for 15 to 20 minutes 3 to 4 times a day to relieve pain and swelling.
- Casting and splinting: If the forearm fracture is not too serious and the bone is correctly positioned, your physician may place the broken forearm in a cast or splint until the bone heals satisfactorily. Most fractures of the forearm may require the application of a cast or splint for 4 to 6 weeks, and sometimes even more if the fracture is severe.
- Closed reduction: For severe angled fractures in which the bones have not broken through the skin, your doctor will gently manipulate and align the bones properly without the need for surgery. This procedure is called closed reduction and is performed under local anesthesia to numb the forearm area. Once the procedure is complete, a cast is applied to hold the bones in place while they heal.
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.
During surgery, your surgeon makes an incision to access the bones in the forearm and repositions the broken bone fragments. This procedure is known as an open reduction. Your surgeon may use temporary fixation devices such as medical pins, plates, or screws to hold the broken bone in place while it heals. These devices may need to be taken out by your surgeon three to six weeks or more after surgery.
Summary
Children love to jump, hop, skip, run, and tumble, all of which are activities that may possibly result in a fracture of the forearm when an unanticipated fall occurs. Forearm fractures in children are very common occurring in 1 out of every 100 children. If a fracture is suspected in a child, you should seek immediate medical attention to ensure proper alignment of the bones so that your child can look forward to a normal and active lifestyle.
