What is a broken forearm?

A broken forearm is a fracture of one or both of the bones that connect the elbow and the wrist. There are two bones in the forearm: The radius bone is on the thumb side of the forearm; the ulna bone is on the pinky finger side.

Forearm fractures are among the most common broken bones during childhood. Broken arms often occur while children are playing and fall unexpectedly.

Fractures of the forearm can occur near the joints of the wrist or elbow, or in the middle of the bone. In most cases, both the radius and ulna bones will break together. The way your child’s forearm breaks will determine its severity, recommended treatment, and how long it will take your child to recover.

There are six types of forearm fractures in children:

• Galeazzi fracture: Both bones in the forearm are affected. In most cases, the radius is broken, and the ulna is dislocated at the wrist joint.
• Greenstick fracture: One of the forearm bones bends and cracks, instead of breaking into separate pieces.
• Growth plate fracture: Affects the layer of growing tissue near the ends of bones and requires immediate care. While either forearm bone may be affected, in most cases the fracture occurs in the radius, near the wrist. Injury to the growth plate can affect the future growth of your child’s bone.
• Metaphyseal fracture: One or both forearm bones may be affected, but the fracture does not affect the growth plate.
• Monteggia fracture: Both bones of the forearm are affected and this injury requires immediate care. In most cases, there is a break in the ulna, and the radius is dislocated at the wrist.
• Torus fracture: Commonly called a buckle fracture, this break compresses the top layer of bone and disrupts the growth plate in the forearm.

If your child sustains a forearm fracture that causes severe pain, breaks the skin, or damages growth plates, treatment should be sought immediately.

Causes

Forearm fractures are common in active children as they play and participate in sports. Breaks in the radius and ulna bones account for more than a third of all childhood fractures.

In most cases, the forearm fracture is the result of an impact injury such as a child falling onto an outstretched arm, a child falling directly onto the forearm, or a child receiving a direct blow to the forearm.

Signs and symptoms

Symptoms of a broken arm may include:

• Immediate, severe pain
• Swelling and tenderness
• Numbness in the forearm, hand or elbow
• Deformity of the forearm, elbow or wrist
• Difficulty turning or rotating the forearm

Additionally, your child may feel the need to support the injured arm with their other hand.

Testing and diagnosis

At Children’s Hospital of Philadelphia (CHOP), diagnosing a forearm fracture typically begins with a physical examination of your child’s arm, wrist and elbow. The physician will look for any deformity of the arm, as well as swelling, tenderness, and an inability to rotate the affected arm.

In most cases, clinicians will recommend X-rays of your child’s forearm to confirm the diagnosis and determine the extent of your child’s injury. X-rays produce images of bones and help doctors identify the type of fracture so they can recommend the best treatment for your child.

In addition to a physical exam and X-rays, your child may also undergo:

• Range of motions tests to determine how the injury is affecting your child’s movement and dexterity
• Nerve assessment tests to determine if the injury has damaged or compressed any nerves in your child’s arm or hand

The more information we have about your child’s condition, the better we can treat their unique injury.

Treatment

Treatment for your child’s forearm fracture will depend on the type of fracture, as well as the age and development of your child.

Nonsurgical treatment

If your child’s forearm fracture is not too severe and the bone is positioned correctly, the broken forearm will likely be placed in a cast until the bone heals.

For children with a simple, displaced fracture — where the bone is not lined up properly — a procedure called a “closed reduction” may be needed to reposition the bone. In this procedure, the bone is straightened without having to open the skin. Clinicians will give your child a local anesthesia to numb the area, and gently push the forearm fragments into alignment.

Once complete, a splint or cast will be applied to keep the bone in place as it heals. Depending on the complexity of the fracture and how much the area swells after the bone is repositioned, a splint may be used for a few days to allow the swelling to recede before a cast is applied.

Surgical treatment

If your child’s forearm fracture is severe, has broken the skin, affected growth plates or cannot be repositioned externally, surgery will be necessary.

A pediatric anesthesiologist will give your child anesthesia to keep them from feeling pain and sensation during surgery. A surgeon will make an incision to access the bones in the forearm and move them into better alignment.

To stabilize the fracture and keep the bones in the correct position as they heal, the surgeon may use a cast, metal pins, plate and screws, an external fixator or a combination of techniques. Your child’s doctor will discuss the best way to immobilize your child’s forearm as it heals.

Surgical safety

Though surgery for forearm fractures is highly effective, we understand that any surgery can be a stressful experience for children and families. At CHOP, we offer a wealth of resources about how to prepare your child for surgery and what to expect during surgery.

Follow-up care

Follow-up care for forearm fractures will depend on the treatment needed. Children with simple fractures who only need casting will be able to resume regular activities more quickly than those who need surgery.

Children with complex fractures who need surgery will wear a cast or external fixator for six weeks. When the cast or external fixator is removed, X-rays will be taken to insure the bones in your child’s forearm are healing properly.

Once the fracture is stable, your child will be encouraged to begin motion exercises to limit stiffness and regain range of movement. Depending on the complexity of your child’s fracture, physical therapy may also be recommended.

Your child’s doctor will give you specific information about a recovery program for your child and how soon they can return to daily activities.

Outlook

Forearm fractures are common in childhood. While your child may experience some stiffness in their arm the first year after the injury, there is typically no lasting impact to movement or activity. Long-term follow-up is not necessary.