Most children's fractures are treated in a cast, and a child's bones heal faster than an adult's [1]. A bent fracture can often be put back into position without an operation; open or unstable fractures need surgery [1]. When the growth plate is involved, follow-up for about a year is advised [1].
Which types of fracture occur?
Forearm fractures in children include [1]:
- Torus (buckle) fracture: one side of the bone is compressed and the bone stays in line; a stable injury
- Greenstick fracture: the break goes through part of the bone and the other side bends
- Metaphyseal fracture: across the shaft, without reaching the growth plate
- Galeazzi: a displaced radius fracture with dislocation of the ulna at the wrist
- Monteggia: an ulna fracture with dislocation of the radial head; a serious injury needing urgent attention
- Growth plate fracture: needs prompt attention because it affects future bone growth
Symptoms and diagnosis
Children report severe pain; numbness in the forearm and hand may suggest the nerve is affected [1]. We check for deformity, tenderness, swelling and loss of rotation and test nerve and blood supply. X-rays of the forearm, elbow and wrist show the extent of the injury [1].
Treatment
Stable fractures need only a cast or splint; a buckle fracture needs 3 to 4 weeks [1].
For fractures that are angled but not complex, the bones are gently pushed into place without surgery (closed reduction) and held in a cast [1].
Surgery is needed for open fractures, unstable or displaced fractures, misaligned bones and fractures that are healing badly; the fragments are repositioned and held with pins, implants or a cast [1].
Healing time
It varies with the fracture: 3 to 4 weeks for a buckle fracture, 6 to 10 weeks for severe injuries such as a Monteggia fracture. After the cast comes off the joint can stay stiff for 2 to 3 weeks and this usually settles without physiotherapy [1].
The bone is temporarily weaker after the cast is removed, so a child should avoid high-stress activities such as monkey bars for 3 to 4 weeks [1].
The growth plate and follow-up
Damage to the growth plate can affect later bone growth, so follow-up visits for about a year are needed to check that growth is normal [1].
When should you seek care straight away?
Go straight away if after a fall your child will not use the arm, if the arm looks deformed, or if there is severe pain or numbness; a child's bones heal faster than an adult's, so treatment must come before the bone heals badly [1].
Frequently asked questions
- Does a child's fracture heal by itself?
- Bones heal quickly, but a misaligned fracture needs early treatment to prevent it healing in the wrong position [1].
- How long does the cast stay on?
- 3 to 4 weeks for a buckle fracture; 6 to 10 weeks for severe injuries [1].
- Does every fracture need an operation?
- No; most are treated in a cast or put back into position without surgery [1].
- What should I look out for after the cast comes off?
- The bone is temporarily weaker; avoid high-stress activities such as monkey bars for 3 to 4 weeks [1].
- What happens with a growth plate fracture?
- Because it can affect growth, the child is followed for about a year [1].
A child with a suspected fracture should be examined and X-rayed without delay.
Sources
- Forearm Fractures in Children. American Academy of Orthopaedic Surgeons (OrthoInfo), n.d.. orthoinfo.org
This article is general information and does not replace an examination or imaging. If you have symptoms, see a doctor.