forearm fractures in children

Forearm Fractures in Children

Description

Symptoms

Nonsurgical Treatment

Surgical Treatment

Children love to run, hop, skip, jump and tumble. But if they fall onto an outstretched arm, they could break one or both of the bones in the forearm.
Forearm fractures account for 40 to 50 percent of all childhood fractures. Fractures can occur near the wrist at the farthest (distal) end of the bone, in the middle of the forearm, or near the elbow at the top (proximal) end of the bone.

Description

Fractures of both forearm bones.

The bones of the forearm are the radius and the ulna. If you hold your arm naturally by your side, the ulna is the bone closer to you and the radius is farther away. About three out of four forearm fractures in children involve the wrist-end of the radius. A child's bones begin to heal much more quickly than an adult's bones. If you suspect a fracture, you should obtain prompt medical attention for the child so that the bones can be set for proper healing.
Types of fractures include:

• Torus fracture: This is also called a "buckle" 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, nondisplaced fracture.
• Metaphyseal fracture: The fracture is across the upper or lower portion of the shaft of the bone and does not affect the growth plate.
• Greenstick fracture: The fracture extends through a portion of the bone, causing it to bend on the other side.
• Galeazzi fracture: The injury affects both bones of the forearm. There is usually a displaced fracture in the radius and a dislocation of the ulna at the wrist, where the radius and ulna come together.
• Monteggia fracture: The injury affects both bones of the forearm. There is usually a fracture in the ulna and the top (head) of the radius is dislocated. This is a very severe injury and requires urgent care.
• Growth plate fracture: Also called a physeal fracture, this fracture occurs at or across the growth plate. Usually these fractures affect the growth plate of the radius near the wrist.

The hand, wrist, arm, and elbow can all be injured during a fall on an outstretched arm. To determine exactly what injuries occurred, the doctor will probably want to see X-rays of the elbow and wrist as well as the forearm. The doctor will also test to make sure that the nerves and circulation in the hand and fingers are not affected.

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Symptoms

This child's forearm fracture has resulted in a bent appearance of the forearm. It will require a manipulation to restore normal alignment prior to placement in a cast.

(Courtesy of Texas Scottish Rite Hospital for Children)

Symptoms of a forearm fracture include:

• Any type of deformity about the elbow, forearm, or wrist
• Acute pain
• Tenderness
• Swelling
• An inability to rotate or turn the forearm

Treatment depends on the type of fracture and the degree of displacement.

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Nonsurgical Treatment

Some may simply need the support of a splint or cast until they heal. If the bones do not break through the skin, the physician may be able to push (manipulate) them into proper alignment without surgery.

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Surgical Treatment

Casts support and protect broken bones while they heal.

Surgery to align the bones and secure them in place may be required if:

• The skin is broken.
• The fracture is unstable.
• Bone segments have been displaced.
• The bones cannot be aligned properly through manipulation alone.
• The bones have already begun to heal at an angle or in an improper position.

After the bones are aligned, the physician may use pins, metal implants, or a cast to hold them in place until they have healed.
A stable fracture, such as a buckle fracture, may require three to four weeks in a cast. A more serious injury, such as a Monteggia fracture-dislocation, may need to be immobilized for six to ten weeks.
If the fracture disrupts the growth plate at the end of the bone, the physician will probably want to watch it carefully for several years to ensure that growth proceeds normally.

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Last reviewed and updated: April 2009

Reviewed by members of POSNA (Pediatric Orthopaedic Society of North America)

AAOS does not review or endorse accuracy or effectiveness of materials, treatments or physicians.


Selected Abstracts

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Sundeep Khosla, L. Joseph Melton III, Mark B. Dekutoski, Sara J. Achenbach, Ann L. Oberg, B. Lawrence Riggs

Incidence of Childhood Distal Forearm Fractures Over 30 Years: A Population-Based Study JAMA 290: 1479-1485.  

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Abstract 1 of 1
Incidence of Childhood Distal Forearm Fractures Over 30 Years

A Population-Based Study
Sundeep Khosla, MD; L. Joseph Melton III, MD; Mark B. Dekutoski, MD; Sara J. Achenbach, MS; Ann L. Oberg, PhD; B. Lawrence Riggs, MD
JAMA. 2003;290:1479-1485.
Context  The incidence of distal forearm fractures in childrenpeaks around the time of the pubertal growth spurt, possiblybecause physical activity increases at the time of a transientdeficit in cortical bone mass due to the increased calcium demandduring maximal skeletal growth. Changes in physical activityor diet may therefore influence risk of forearm fracture.
Objective  To determine whether there has been a changein the incidence of distal forearm fractures in children inrecent years.
Design, Setting and Patients  Population-based study amongRochester, Minn, residents younger than 35 years with distalforearm fractures in 1969-1971, 1979-1981, 1989-1991, and 1999-2001.
Main Outcome Measure  Estimated incidence of distal forearmfractures in 4 time periods.
Results  Comparably age- and sex-adjusted annual incidencerates per 100 000 increased from 263.3 (95% confidenceinterval [CI], 231.1-295.4) in 1969-1971 to 322.3 (95% CI, 285.3-359.4)in 1979-1981 and to 399.8 (95% CI, 361.0-438.6) in 1989-1991before leveling off at 372.9 (95% CI, 339.1-406.7) in 1999-2001.Age-adjusted incidence rates per 100 000 were 32% greateramong male residents in 1999-2001 compared with 1969-1971 (409.4[95% CI, 359.9-459.0] vs 309.4 [95% CI, 259.3-359.5]; P = .01)and 56% greater among female residents in the same time periods(334.3 [95% CI, 288.6-380.1] vs 214.6 [95% CI, 174.9-254.4];P<.001). The peak incidence and greatest increase occurredbetween ages 11 and 14 years in boys and 8 and 11 years in girls.
Conclusions  There has been a statistically significantincrease in the incidence of distal forearm fractures in childrenand adolescents, but whether this is due to changing patternsof physical activity, decreased bone acquisition due to poorcalcium intake, or both is unclear at present. Given the largenumber of childhood fractures, however, studies are needed todefine the cause(s) of this increase.

Author Affiliations: Endocrine Research Unit, Division of Endocrinology, Metabolism, and Nutrition, Department of Internal Medicine (Drs Khosla and Riggs), Department of Health Sciences Research (Drs Melton and Oberg and Ms Achenbach), and Department of Orthopedic Surgery (Dr Dekutoski), Mayo Clinic and Mayo Foundation, Rochester, Minn.
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