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Types

• Physeal (Growth Plate) Fracture: This type involves the growth plate, especially common near the wrist. These fractures have a high potential for natural remodeling, particularly in younger children. Learn More

• Torus or Buckle Fracture: This occurs when one side of the bone compresses and buckles without breaking completely through. It’s like pressing down on a paper towel roll until it buckles. The other side remains intact.

• Greenstick Fracture: Here, one side of the bone breaks while the other side bends. Children’s bones are softer and more flexible, leading to this type of fracture.

• Plastic Deformation Fractures: These involve bending of the bone without a complete break. The bone appears bowed on an X-ray, though no fracture line is visible.

• Complete Fractures: These fractures result in the bone being fully separated, with the ends no longer touching.

• Monteggia Fractures: This type features a fracture of the ulna with a dislocation of the radial head near the elbow.

• Galeazzi Fractures: This injury involves a fracture of the radius and dislocation of the ulna at the wrist.

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Symptoms

Signs of a forearm fracture include a deformed or crooked arm, swelling, pain, inability to move the arm, and bruising. In severe cases, there may be an open wound with bleeding, requiring immediate emergency care to prevent infection. Numbness or tingling in the hand or forearm also warrants urgent medical attention. Persistent pain, even without visible deformity, can indicate a fracture.

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Diagnosis & Treatment

Examination

The doctor will assess the skin for bruising and swelling, palpate (examine by touching) the forearm, elbow, and wrist to identify pain, and gently move the joints. Checking the nerves and blood flow to the hand is also crucial.

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X-Rays and Tests

X-rays are typically sufficient to diagnose a forearm fracture and may include imaging of the wrist and elbow if needed. In some cases, a CT scan might be used for a more detailed view.

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Non-Operative Treatment

Most forearm fractures are treated without surgery. Stable fractures like buckle or torus fractures generally require a splint or cast for 3 to 4 weeks. 

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If the bones are misaligned, realignment may be needed, either in the clinic, under sedation, or in the operating room. Some angulation and displacement are acceptable in younger children due to their rapid healing. Follow-up X-rays in 7 to 10 days may be necessary to ensure proper healing.  A cast is typically worn for 6 to 12 weeks, with potential changes from a long arm cast to a shorter cast at the 6-week mark.

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Operative Treatment

Surgery might be required if:

• There is a skin laceration near the fracture.
• The bones fail to stay aligned in a cast.
• The bones are healing in an incorrect position.
• The fracture is near the elbow with misalignment.

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Surgical options may involve temporary pins, plates, or screws to stabilize the bones. Post-surgery, a cast or splint may still be used to support healing.

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Outcomes

Fractures near the wrist typically heal quickly, while those in the middle of the forearm may take longer and have a higher risk of re-fracture. Stiffness in the elbow or wrist is common after cast removal and usually resolves on its own, though physical therapy may be needed in rare cases. To prevent re-fracture, avoid sports and physical activities for 4 to 6 weeks after cast removal. For fractures involving the growth plate, follow-up X-rays in 6 to 12 months may be recommended to ensure normal bone growth.

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