Introduction
The radius is the bone on the thumb side, and the ulna is the bone on the little finger side. These two bones together form the forearm. Fractures in the forearm can occur near the wrist, close to the elbow, or in the middle section of the forearm. Additionally, children are more prone to a certain kind of injury known as a growth plate fracture. The growth plate is composed of cartilage, which is a soft, flexible type of tissue. It is located at the ends of the bones in children and helps determine the final length and shape of the fully grown bone.
Fractures in children tend to heal faster compared to those in adults. Therefore, if a fracture is suspected in a child, it is important to get prompt medical care to ensure the bones are properly aligned.
Types of 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)
Causes
Forearm fractures in children commonly happen when a child falls on an arm that is stretched out or when the forearm is struck directly, causing a break in one or both of the bones in the forearm, which are called the radius and ulna.
Signs and Symptoms
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 discoloration of the skin
- Popping or snapping sound during the injury
Diagnosis
Forearm fractures in children can be diagnosed by analyzing X-ray images of the wrist, elbow or the forearm.
Treatment
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 tell you to place an ice pack covered with a thin towel on the injured area for 15 to 20 minutes, three to four times each day. This helps reduce pain and swelling. If the fracture is severe but the bones have not broken through the skin, the doctor will carefully realign the bones without performing surgery, which is called closed reduction. For a stable buckle fracture, a splint or cast might be needed for three to four weeks. For more serious fractures, the doctor may recommend keeping the injured area still for six to ten weeks.
Surgical Treatment
Surgery may be necessary for severe fractures, especially those involving the growth plate or a joint. Other cases, such as when the skin is broken, the bones are not in their correct position, the fracture is unstable, the bones are misaligned, or the bones are healing in an incorrect position, may also need surgical intervention. The surgeon will first carefully place the bones into the correct position by making a cut in the skin. Then, they will use tools like pins or metal implants to hold the bones in place while they heal. A cast or splint may be used to help keep the bones properly aligned throughout the healing process.
Conclusion
In the long run, your child's forearm might appear slightly different or bent compared to how it looked before the break, which is a normal part of the healing process. It can take about 1 to 2 years for the bones in the forearm to become straight again as they go through a process called remodeling, which is when bones reshape themselves. If the fracture involved the growth plates, the doctor will keep a close watch on the hand over several years to make sure the growth continues normally.
