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Forearm Fractures

These fractures account for > 40% of all childhood fractures. About 3 out of 4 (75%) forearm fractures in children occur at the distal radius. It's most commonly caused by a:

  • Fall onto an outstretched hand (FOOSH)

  • Fall directly on the forearm

  • Direct blow to the forearm


Types

  • Torus fracture (“Buckle” fracture) - The topmost layer of bone on one side is compressed, causing the other side to bend away from the growth plate. This is a stable fracture.

“A Radiograph Image of a Torus (Buckle) Fracture” © Apaul291003 CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0/)

  • Greenstick fracture - Fracture extends through a portion of the bone, causing it to bend on the other side.

“Greenstick fracture of the ulna and radius (forearm fracture).” © Hellerhoff CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/)

  • Galeazzi fracture - Fracture affecting both bones of the forearm. Displaced fracture in the radius and a dislocation of the radio-ulnar joint.

“Short oblique fracture of the shaft of the radius with (→) complete dislocation of the distal end of the ulnar joint (“distal radioulnar joint”).” © Thomas Zimmermann CC BY-SA 3.0 DE (https://creativecommons.org/licenses/by-sa/3.0/de/)

  • Monteggia fracture - Fracture affecting both bones of the forearm. Fracture in the ulna and a dislocation of the proximal radial head. This is a very severe injury and requires urgent care.

“X-ray of Monteggia fracture of right forearm, showing fracture of ulna and dislocation of radius” © Jane Agnes CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0/)

N.B. Remember the mneumonic GRUesume MURder! Galeazzi: R-radial fracture + U-ulnar dislocation. Monteggia: U-ulnar fracture + R- radial head dislocation.


  • Metaphyseal fracture - Fracture is across the upper/lower portion of the shaft.

  • Growth plate fracture (“Physeal” fracture) - Fracture at the growth plate, most commonly at the distal radius. This type of fracture requires prompt attention as the growth plate helps determine the future length and shape of the mature bone.


Management

  • Nonsurgical Treatment:

    • Casts/splints can be applied for the stable fractures, such as buckle fractures.

    • If fracture has become angled, simple closed reduction and manipulation can be done before the cast/splint is applied

  • Surgical Treatment - This will likely be considered if:

    • Open fracture (bone has broken through the skin) due to the risk for infection

    • Unstable fracture (ends of broken bones won’t stay aligned)

    • Broken bone ends can’t be aligned through manipulation alone

    • Dsiplaced bone segments

    • Bones have already began to heal at an angle/improper position



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