Forearm Fractures
The forearm is made up of two long bones: the radius, which lies on the thumb side, and the ulna, found on the small finger side. Fractures can occur anywhere along these bones—from the elbow to the wrist—and may sometimes be associated with a dislocation, where a bone slips out of its joint. In growing children, these injuries can also involve the growth plates, which are areas of developing cartilage that are structurally weaker than bone and therefore more prone to injury.
Forearm fractures are among the most common injuries in children, accounting for up to 50% of all pediatric fractures and affecting approximately 1 in 100 children. While many cases heal well with simple immobilization, others may require more active management.
Common Causes
Most forearm fractures in children occur from falls onto an outstretched hand—a natural instinct when trying to break a fall. The force of impact travels up the wrist and forearm, leading to a break in one or both bones.
Other causes include:
- Sports injuries, especially in activities like soccer, gymnastics, skateboarding, or biking.
- Playground accidents, such as falling off monkey bars or swings.
- Direct trauma, for instance, being struck on the arm during contact sports or by an object.
- High-impact incidents, including car or bicycle accidents, which may cause more complex fractures involving both bones or the joints.
Because children’s bones are still developing, their unique structure (softer, more flexible bone tissue) can result in special types of fractures, such as greenstick fractures, where the bone bends and partially breaks.
Symptoms
The symptoms of a forearm fracture are usually immediate and easy to recognize. Common signs include:
- Pain and tenderness along the forearm, wrist, or elbow.
- Swelling and bruising around the injured area.
- Deformity or an unusual bend in the arm, especially if both bones are broken.
- Difficulty moving the wrist or elbow due to pain.
- In severe cases, numbness or tingling, which may suggest nerve involvement.
If a child complains of pain after a fall and refuses to use the arm, a fracture should be suspected and evaluated promptly.
Diagnosis
A healthcare provider will typically perform a physical examination and order X-rays to determine the location and type of fracture. Sometimes, both forearm bones are imaged even if only one appears injured, to check for associated damage. In complex cases, CT scans may be used to assess joint involvement or displacement.
Treatment
Treatment depends on the severity and type of fracture:
- Casting or Splinting:
The majority of pediatric forearm fractures are nondisplaced (the bones remain properly aligned) and can be treated with a cast or splint for several weeks. - Closed Reduction:
If the bones are slightly out of place, a closed reduction (manual realignment) is performed before applying a cast. This procedure is often done under sedation or local anesthesia. - Surgical Treatment:
For severely displaced, open, or unstable fractures, surgery may be necessary. The bones may be stabilized with pins, plates, or rods to ensure proper alignment during healing.
During recovery, children are often encouraged to move their fingers and shoulder to maintain flexibility, while avoiding activities that risk re-injury.
Recovery and Outcomes
Children’s bones have an excellent capacity to heal, often faster and more completely than adults’. Most fractures heal within 4–8 weeks, depending on the child’s age and the nature of the injury.
After the cast is removed, mild stiffness and weakness are common but typically resolve with normal use. In some cases, physical therapy may be recommended to restore strength and range of motion.
Long-term complications are rare but may include:
- Malunion (healing in a slightly incorrect position)
- Growth plate disturbances, potentially affecting bone length
- Persistent stiffness or decreased rotation of the forearm
With prompt and appropriate treatment, the vast majority of children recover full function without lasting problems.
Conclusion
Forearm fractures are a frequent and generally well-managed injury in children. Awareness of the causes, symptoms, and treatment options can help parents and caregivers respond quickly and effectively. Early medical attention ensures optimal healing, allowing children to return safely to their usual activities.
Luskin Orthopaedic Institute for Children
Los Angeles's best in Pediatric Orthopaedic Care Since 1911
