Anyone with children knows they always have to do things differently – this includes when they hurt themselves, and broken bones aren’t an exception.
The most common fractures involve the forearm, as kids naturally put out their arms to brace themselves. Fractures can also result from a direct fall onto the arm, or a blow to the arm. Most forearm fractures occur towards the wrist.
Bone growth occurs not from the centre of the bone but rather from the growth plate, which are translucent, cartilaginous discs near the end of the bone. By late adolescence the growth plates throughout the body fuse and bone growth ceases. Any damage to a growth plate as a result of a fracture can lead to altered, interrupted or impaired growth; growth can even cease altogether.
The forearm is comprised of two bones, the ulna and the radius, with the radius being on the thumb side of the forearm, the ulna on the other. Treatment depends upon the type of fracture, and how much the bones have been displaced.
Types of Fractures in Children
- a buckle or torus fracture: the bone is compressed on one side, causing the other side of the bone to bend away from the growth plate. (Tori is the Latin for a protuberance.) It is an incomplete fracture (the bone has not broken completely through) and occurs most commonly in children aged 5-10, largely due to the elasticity of their bones, and usually near the wrist.
- a metaphyseal fracture – the fracture occurs across the shaft of the bone, and the growth plates are not involved. Usually a result of a fall on an outstretched hand, they occur most commonly during the adolescent growth spurt, when the metaphysis is weakened by accelerated growth.
- a greenstick fracture: another incomplete fracture, this is when the bone bends and cracks, much like a small green branch on a tree. Like a branch, the break occurs on the outside of the bone.
- a Galeazzi fracture: both of the bones of the forearm are affected. The far third of the radius is fractured, and the ulna is dislocated at the wrist, but not fractured.
- a Monteggia fracture: here the upper third of the ulna is fractured and the radius is dislocated, where it joins with the elbow. Such fractures usually require surgery.
- a physeal or Salter-Harris fracture: the fracture involves the bone’s growth plate, or physis. The growth plate is the softest part of a skeleton; what would cause a sprain in an adult can cause a physeal fracture in a child. In the arm, it is usually the growth plate of the radius, near the wrist, which is affected. Reassuringly, most treated physeal fractures heal without complication.
Since a child’s broken bones heal quickly, a delay in treatment can result in bones healing in a poor position. Stable fractures usually require a splint or, more commonly, a cast. This not only holds the bones in place while they heal, they protect both bone and child against further injury. Some displaced fractures can be manipulated back into place without the need for surgery, after which they will be immobilised in a cast.
The types of fractures needing surgery include compound fractures (where the bone has pierced the skin), unstable fractures where the bones fail to remain aligned even with a cast, or when bones have already begun to heal but in poor alignment.
Depending upon the type and severity, casts may be needed from 4 to 10 weeks or occasionally longer. Afterwards, the wrist and elbow joints may be stiff. Children are usually active enough for complete movement to return without treatment, although occasionally physiotherapy is needed.
Learn more about broken bones and healthy bones, young and old, in our Bone Trivia – Fun and Facts.