All You Need To Know About Pediatric Forearm Fractures
The forearm is located between the wrist and the elbow. It is formed by two bones, the radius and the ulna. Forearm fractures frequently happen in childhood, accounting for over 40 per cent of all childhood fractures. Around 75 per cent of all pediatric forearm fractures occur at the wrist end of the radius.
Usually, forearm fractures happen when children are participating in sports or playing on the playground. If a child happens to fall and land onto an outstretched arm, a forearm fracture may possibly occur. Because children’s bones heal faster than adults’, it is crucial to treat the fracture straight away before healing begins. This is to avoid future complications.
Which part of the arm does it concern?
As mentioned, the forearm is formed by two bones, the radius and the ulna. The radius is located on the side of the forearm where the thumb is. The ulna, on the other hand, is located on the side where the pinky finger is.
Both the radius and ulna have growth plates. Growth plates are areas of cartilage located near the ends of the long bones in children and adolescents. The long bones of the body do not grow from the centre outward. Instead, growth occurs at each end of the bone around the growth plate. The growth plates then harden into solid bone when a child is fully grown.
What are the different kinds of pediatric forearm fractures?
Fractures can take place in either one or both bones of the forearm, and in several locations along the bone:
- Near the wrist, at the farthest (distal) end of the bone
- In the centre of the forearm
- Near the elbow, at the top (proximal) end of the bone
How are forearm fractures differentiated?
A torus fracture is also known as a buckle fracture. In this fracture, the topmost layer of bone on one side of the bone is compressed, causing the other side to bend away from the growth plate. This is a stable fracture, which means that the broken fragments of bone are not displaced.
This fracture occurs across the upper or lower portion of the shaft of the bone and does not affect the growth plate.
A greenstick fracture extends through a portion of the bone, causing it to be bent on the other side.
In this fracture, both bones of the forearm are affected. Normally, there is a displaced fracture in the radius and a dislocation of the ulna at the wrist, where the radius and ulna come together.
A Monteggia fracture is a very serious injury and requires immediate care. This fracture also affects both bones of the forearm. Typically, there is a fracture in the ulna and the head of the radius is dislocated.
Growth plate fracture
Also known as a physeal fracture, this fracture takes place at or across the growth plate. Most of the time, this kind of fracture takes place in the growth plate of the radius and near the wrist. It is crucial to get this kind of fracture treated immediately. This is because the growth plate helps to determine the future length and shape of the mature bone.
What causes pediatric forearm fractures?
Children enjoy running, skipping, hopping, jumping and tumbling. These are all activities that can potentially result in a forearm fracture if a fall happens. Most of the time, pediatric forearm fractures are caused by a fall onto an outstretched arm, a fall directly on the forearm or a direct blow to the forearm.
What are the symptoms of a pediatric forearm fracture?
The common symptoms of a pediatric forearm fracture are:
- Popping or snapping heard during the injury
- Bruising or colour change in the skin
- Severe pain, especially while applying weight or pressure on the forearm
- Crooked or deformed appearance
- Inability to move the arm normally
- Numbness in the forearm and hand, a sign of potential nerve injury
How is a doctor evaluation carried out?
First, the child’s symptoms and medical history will be discussed. Next, a careful examination of the arm will be conducted to determine the extent of the injury. The doctor will look out for tenderness, swelling and deformity around the wrist, forearm or elbow. The ability to rotate or turn the forearm will also be tested. In addition, the doctor will check if the nerves and circulation in the hand and fingers have been affected.
X-rays are able to produce clear images of dense structures such as bones. The hand, wrist, arm and elbow are all prone to injury from a fall on an outstretched arm. As such, the doctor may order X-rays of the elbow, wrist and forearm to determine the extent of the injury.
How are pediatric forearm fractures treated?
The type of treatment is dependent on the kind of fracture and degree of displacement. One of the following treatments or a combination of both will be used.
For certain stable fractures like buckle fractures, all that is may be needed is the support of a cast or splint while healing takes place. Casts are able to provide the broken bones with support and protection while they heal.
As for more complex fractures that have become angled, the bones may be manipulated or gently pushed into place without the need for surgery. This is known as a closed reduction. Afterwards, the arm is immobilised in a cast or splint while healing takes place.
In certain cases, surgery may be needed to align the pieces of bone and hold them in place. Surgery may be recommended if:
- The fracture is unstable, as the ends of the broken bones will not remain lined up
- The bone segments have been displaced
- The bone has broken through the skin — this is known as an open fracture and is at risk for infection, requiring special treatment
- The bones are already starting to heal at an angle or in a wrong position
- The bones are unable to be aligned properly through manipulation alone
During the procedure, the skin is opened and the broken pieces of bone are repositioned. This is known as an open reduction. A cast, pins or metal implants may be used to hold the broken bones in position until they have healed.
What does the recovery process of a pediatric forearm fracture look like?
The severity of the fracture will determine how long the cast needs to be worn. Stables fractures like a buckle fracture may only need 3 to 4 weeks in a cast. On the other hand, more complex fractures like a Monteggia fracture may require immobilisation for 6 to 10 weeks.
It is normal for the wrist and elbow joints to feel stiff for 2 to 3 weeks after the cast is removed. Normally, this stiffness will disappear on its own without the need for any physical therapy.
For a while, the forearm bones may be weaker because of immobilisation in the cast. In order for the bones to safely regain their normal strength, one should avoid playing on playground structures, such as monkey bars, for 3 to 4 weeks after the cast is removed.
If the growth plate at the end of the bone is disrupted by the fracture, the development of the bone could be affected. In such cases, follow-up visits to the doctor may be recommended for a year to make sure that growth is proceeding normally.