Forearm Fractures

Understanding Pediatric and Adult Forearm Fractures

Forearm fractures are common upper extremity fractures in kids and adults alike, as they compose the part of the arm which is integral in everyday activities, sports and hobbies – and frequently utilized to slow the force of an impact or fall.

Fracture of one of the forearm bones

Forearm bones and illustration of a forearm fracture.

The forearm bones are known as the ulna and the radius.  They run parallel to one another and connect the wrist joint (distal end) to the elbow joint (proximal end).

A forearm fracture can affect one or both forearm bones.  In fact, the impact one forearm bone sustains often forces it into the other causing both to break.

When a forearm fracture occurs, the type of break is carefully assessed using both a physical examination and x-rays.  It is then identified as a fracture involving either the proximal, middle or distal “shaft.”

Some of the common types of forearm fractures include:

  • Radial Head Fractures
  • Olecranon Fractures
  • Distal Radius Fractures (wrist fracture)
  • Radial Shaft Fractures,
  • Ulnar Shaft Fractures
Both bone forearm fracture in a young football player

An x-ray of a both bone forearm fracture in an adolescent football player.

The fracture is identified based on a set of criteria and the location on the bone.  If both the radius and the ulna are affected, it is known as a “both bone forearm fracture.”

If the fracture does not pierce through the skin it is considered a simple or closed fracture.  One that pierces through the skin is considered a complex or open fracture.

Forearm Fractures in Children

Forearm fractures represent nearly half of all childhood fractures – most of those occurring at the distal, or wrist end of the radius. These fractures are classified by the area of the bone affected, whether it is stable or displaced, how clean the break and whether it is partial or complete across the bone.

The classifications include:

  • Torus fracture, also known as a “buckle” fracture.  It results when the top layer of bone on one side compresses upon a harsh impact.  It is considered a stable fracture.
  • Metaphyseal fracture.  This type of fracture affects the upper or lower shaft of the bone without affecting the growth plate.
  • Greenstick fracture.  This type of fracture extends through part of the bone, causing it to bend on the other side.
  • Galeazzi fracture.  This impact is often a displaced fracture disrupting the radius and also the wrist joint where the radius and ulna come together at the wrist.
  • Monteggia fracture.  This fracture usually involves the ulna shaft and disrupts the elbow joint where the radius dislocates requiring urgent care.
  • Growth plate fracture. This type of fracture occurs across the growth plate.

(Fracture classifications source:  American Academy of Orthopaedic Surgeons)

Fractures in children are different from those in adults, because their bones are still growing.  As a result, they have more cartilage and collagen resulting in a more “pliable” bone less subject to a break – or one less severe as an adult might sustain with the same impact.  In fact, many fractures in children may be so subtle they are difficult to detect on an x-ray and require an orthopedic specialist to assess.  A fracture in a child heals rapidly.  So, it is important that it is addressed quickly and properly set before it heals in improper alignment – causing other long term problems.

Also unique in children is the impact a fracture could have on their growth plates.  Depending on the extent of a fracture, the growth and function of the child’s limb could be negatively impacted as a result.

Adult Forearm Fractures

The same fracture classifications applied to those in children, with the exception of growth plate and greenstick fractures, apply to those in adults.  The adult bone is less “pliable” than that of a child’s and has a higher tensile strength, which can result in a more serious break.

Adults suffering from osteoporosis are particularly subject to breaks from an impact or activity seemingly unlikely to inflict such damage.

Treatment

Fracture treatment depends on the severity of the break and any other soft tissue damage that may have occurred as a result.  The right treatment will depend on the fracture, age and lifestyle of the patient – and may be nonsurgical or surgical with internal fixation.

All treatment includes hand therapy for the best results and most rapid return to activity.

The Different Types of Fractures

A fracture is a break in the bone. Within the hand and upper extremity it can occur anywhere from the fingertip to the shoulder.

Among the most common fractures and dislocations of the hand and upper extremity include:

  • Finger Fractures
  • Distal Radius Fractures (also called Colles Fracture)
  • Scaphoid Fractures
  • Forearm Fractures
  • Clavicle Fractures (collar bone)

There are a number of different types of fractures – partial or complete, simple or compound, clean or shattered …each with their own classifications.  It is important to first define the type of fracture and its severity before determining the most effective treatment plan.

Fractures are defined by the severity of the break and the impact it imposes to surrounding tissue. Some fractures known as partial fractures may only cause a slight crack in the bone, while others may result in a complete break or shattered bone.

A fracture may also be either open or compound, which is a fracture that pierces through the skin creating an open wound.  A closed or “simple” fracture is a fracture that does not break through the skin.

Other classifications that help determine the best treatment plan for your type of fracture include:

  • Transverse Fracture – A fracture that goes across the bone and is situated at a right angle to the long axis of the bone.
  • Greenstick Fracture – A fracture situated on only one side of the bone, causing a bend but not a complete break. These are most commonly seen in children with more “pliable” bones.
  • Comminuted Fracture – A fracture that results in three or more bone fragments.
  • Intra-articular Fracture – A fracture with joint involvement.

Depending on the severity of the fracture, treatment may entail the non surgical realignment of the bone and casting, also referred to as closed reduction. Or surgical repair utilizing fixation support may be indicated.