Paediatric Distal Radius & Forearm Fractures

The notes on this page are written as a source of information to both patients and health professionals. It is a general overview and its content should not be seen as direct medical advice. Further information regarding diagnosis and treatment specific to your condition can be made via a consultation with Dr Amaranath.

Anatomy

The radius and ulna make up the two bones in the forearm. Both of these bones have growth plates that are areas where bone growth occurs. Damage to these regions can affect long term bone growth.

The structural composition of paediatric bones differs from adults. Children’s bones tend to be softer and more flexible. This leads to different fracture patterns following trauma and cause the bones to bend before they break.

What are the common types of fractures in children?

There are four main fracture patterns in children: 

  1. Buckle fracture – These are commonly caused due to compression of the bone and lead to buckling of the cortex.

  2. Greenstick fracture – These are incomplete fractures of the bone, when one cortex is broken and the other remains intact.

  3. Plastic deformity – This is when bones bend without any break in the cortex.

  4. Complete fracture – This is when both cortices of the bone are broken.

What are the preferred Investigations/Imaging?

Plain X-Ray of the wrist or forearm - This should include an Anterior/Posterior and Lateral views.

What are the treatment options?

  1. Non-operative – This is the most common treatment option for children’s fractures. Small degrees of deformity and buckle fractures tend to be placed in a cast for a period of 4-6 weeks. Greenstick fractures and complete fractures may require a closed reduction and application of a moulded cast. The reason why this is acceptable in children is due their remodelling potential. Deformities tend to correct overtime as the bone grows.

  2. Open Reduction and Internal Fixation (ORIF) – In children that have significantly displaced fracture fragments, are older or have a failed closed reduction (meaning the fracture fragments are not able to be held by a moulded cast), tend to require an operation. The operation may include the introduction of smooth stainless-steel wires, small flexible titanium rods or a plate with screws. This will be dependent on the fracture type, location of the fracture and age of the child. In most cases once the bone has healed the implant will be removed.

What does the rehabilitation/recovery involve?

To find out more about rehabilitation and recovery after upper limb surgery please see our Rehabilitation Protocols here.