Bones in children are different from bones in adults. They break differently and they respond differently to injury.
Some fractures occur both in adults and kids – some fractures occur only in children. Forearm fractures occur in both, with some important differences. This article will cover some of the basics of forearm fractures in kids.
The forearm is a unique structure which provides stability and mobility at the same time. The forearm is made up of two bones – the radius and the ulna. The bones can be broken at any point along the shaft of the bone – down by the wrist, at the middle of the bone’s shaft, or up by the elbow.
How the bones are broken
Fracture of both bones of the forearm may occur directly or indirectly by force.
Direct injuries happen when a child falls directly on the forearm, or something hits the forearm with a direct impact. This could be during a fall onto the sharp edge of a curb, or if a child is hit with a baseball bat or other blunt object.
Indirect injuries are much more common – they happen when a child puts her hand out to break her fall and the force from the fall travels up the forearm and breaks both bones.
How the diagnosis is made
Fractured forearms are usually pretty obvious when the doctor sees the patient. There’s usually a pronounced deformity that involves swelling or bruising of the forearm area. If the break is near the wrist or elbow, those areas may be swollen as well, and the child will refuse to move the joints around the fracture (even the fingers).
Xrays are a critical part of making the diagnosis of a forearm fracture. Other tests like CT scan and MRI are almost never necessary.
In children, bone fragments are usually not displaced (moved out of place) because the periosteum (covering over the bone) is thick and functions as an extra layer that contains the pieces of the fracture.
How forearm fractures are treated in children
In childhood, conservative treatment is usually successful. Most forearm fractures don’t need to be straightened out in surgery. A cast is the most common treatment. Sometimes the cast is put on after a week or two in a fiberglass or plaster splint.
Kids rarely need surgery. However, “surgery” needs to be defined here.
Surgery on kids’ fractures could be anything from simply pushing on the arm with the child asleep in the operating room, to making an incision over the bone and moving the pieces with bone clamps.
The most common surgery in kids’ forearm fractures is when the surgeon straightens the bones and puts a splint on the arm while the child is asleep. No pins, no incisions required.
The more the pieces are moved out of place and the older the child, the more likely it is that surgery will be necessary for correct healing.
Other reasons for taking a child to surgery for a broken forearm:
- the bones are partially healed in the wrong position – a bad angle or not lined up at all
- the surgeon or doctor in the ER tries to line up the pieces but they don’t line up well or won’t stay lined up after a week or so
- pieces of the broken bones are highly displaced (moved out of place)
- it’s a compound, or open fracture – pieces of the broken bones came through the skin
Complications from pediatric forearm fractures
Complications are rare. The most common problems involve stiffness and leftover deformity of the bones.
It’s common for the forearm to look crooked after the cast comes off. The younger the child, the faster and better the body straightens out deformities.
Usually, even if the bones aren’t perfectly straight on the xrays, the arm functions normally and the mild deformity doesn’t prevent the child from doing anything she wants to do.
Some parents don’t want any deformity at all and are more aggressive about wanting surgery – other parents are OK with most of the straightening happening after the cast comes off. This is why having an open discussion in the office is so important!
What restrictions are necessary during the healing of a forearm fracture?
The same restrictions apply whether treating an adult or a kid who has a fractured forearm:
- no lifting
- no weight bearing or pushing with the arm
- keep fingers moving
- light activities like writing and playing video games are fine
Sometimes the most frustrating part of recovery involves dealing with the cast – keeping it clean, dry, and comfortable.
How long is the recovery time from a forearm fracture?
Healing time depends on the severity of the forearm fracture. Fractures in children generally heal in 6 weeks.
The younger the child, the faster the bones heal. Past 4 years old, the process takes a full six weeks.
Declaring a fracture healed is a combination of
- healing on the xray
- lack of pain when the doctor pushes on the arm
After the bone has healed, the arm will be stiff for several days. This usually goes away with time without any physical therapy.