Forearm fracture in the child
Synonym in a broader sense
- Distal forearm fracture
- Distal radius fracture (distal = located away from the body; here consequently near the wrist
- Fracture (fracture) of the lower end of the forearm or wrist in childhood
- Wrist fractures
- Broken spoke
introduction
The forearm consists of two bones, the ulna and the radius. In many cases, only one of the bones breaks
The distal radius fracture (broken wrist / broken spoke) is the most common fracture in childhood, but also the most common fracture of the human skeleton. It usually arises when the child falls and tries to protect himself from hitting the ground with his hands. So there is usually a fall on the outstretched hand.
But falling on the kinked hand can also lead to a fracture of the forearm bone. In the majority of cases the spoke (radius) affected.
A complete forearm fracture means that both bones are broken. Since the ulna and radius are necessary for unrestricted movement of the arm and hand, the complete fractures almost always have to be operated on.
Complete forearm fractures make up about a third of all forearm fractures in childhood. Forearm fractures are the most common fractures in children and therefore the number of complete fractures is relatively high.
Pain
Broken bones can be very painful. Although bones themselves have no pain-conducting nerves, the periosteum is very sensitive to pain and well supplied with nerves. In addition, if the fractures are displaced, the surrounding tissue can also be damaged and thus lead to severe pain. Movement of the forearm and wrist is usually not possible due to the pain.
Forms of the forearm hernia
A distinction is made in the distal (end of the hand) forearm area three types of fractions:
- Greenwood fracture / greenwood fracture
- Compression fracture above the growth plate (bulge fracture)
- Bend fracture above the growth plate
- Dissolution of the epiphysis (growth plate) of the spoke with or without a wedge-shaped fragment above the epiphysis
They represent the most common injuries of the Poor The specialty of the lower area of the forearm is the high growth potential. Spontaneous corrections are therefore possible.
On topic "Broken bones in childhood“You can read more about the type of fractures and their spontaneous correction.
Greenwood fracture
The child's bones are still elastic within certain limits.
In the case of a greenwood fracture, the bone breaks on the tension side and the compression side bends. The greenwood fracture gets its name because the child's bone has the property of breaking like a green twig. So it doesn't break through completely, but bursts apart without breaking.
Right picture
- spoke
- Cubit
- Greenwood fracture
Read more about the topic here: Greenwood fracture.
Compression fracture / bulge fracture
In the event of compression fracture / bulge fracture, compression occurs. That means the bone is being pressed together by force.The periosteum (periosteum) is preserved and does not tear when injured.
Illustration on the right
- Carpal bones
- Compression fracture / bulge fracture
- Spoke (radius)
- Growth plates (epiphyses)
- Ulna
therapy
The therapy of the child's forearm fracture / spoke fracture is similar to that of the fracture in adulthood. However, compared to the mature human skeleton, the child's bones have the ability to develop further. Therefore, such forearm fractures with slight misalignments can "grow together" in childhood, as the saying goes.
Therapy usually takes place conservative by immobilizing the plaster. The plaster cast should be worn for 3 to 4 weeks. Thanks to the high growth potential of the affected region, the spontaneous healing of the bone rarely causes problems. If necessary, a repeated X-ray can be arranged for a follow-up check. However, the doctor decides this individually.
However, which form of therapy should be sought must always be decided individually. In particular, if the fractures are displaced or if the vessels and nerves are injured, the fracture often has to be treated surgically.
Is a Reduction, so a return to the initial state, the bones needed, so this should be in a anesthesia respectively. Reduction is painful and requires the child to hold still.
The corrected position of the bones may not hold by itself. In these cases additional nails, screws and plates can be used to provide additional stability.
Thereafter, healing usually proceeds without any external influence. You can support through homeopathy.
Read our topic: Broken bones and homeopathy.
When does my child need an operation?
A fracture of the forearm in children cannot always be treated with a plaster cast. In certain cases it makes sense to choose an option of surgical treatment so that the bone heals optimally and there is no growth disturbance of the bone in the course. It must be noted that there are a number of different surgical therapies and range from very complex procedures to minimally invasive techniques.
In addition to the type and location of the fracture, the age, weight and size of the child also play a major role in the choice of therapy. In general, however, in the case of an unstable fracture, an operative procedure is usually sensible to fix the bone in its natural position. Even if it is an open fracture (the bone protrudes from the skin), an operation must be carried out. If the break lies within the growth plate, the type of break and the position of the bones determine whether surgical therapy is necessary. The attending physician can use the X-ray images and a physical examination to estimate which therapy method makes the most sense in the individual case and make a recommendation.
You might also be interested in this topic: X-ray examination of the child
Complications of forearm fractures in the child
As with all injuries, forearm fractures can cause complications. In children, four complications are highlighted. Since operations are avoided as far as possible in children and conservative treatment is used, the bones in the already injured area can break again if the stress is too early. This is less common with broken points secured with plates.
The second complication is long-term restriction of movement of the forearm. The forearm, consisting of ulna and radius, is actually a joint that guides the turning movement of the hand through a movement of the forearm bones. This movement can be restricted in poorly healed fractures.
The third complication is soft tissue damage. This summarizes bleeding into the muscle or damage to the nerves and vessels. Damage to the nerves can lead to permanent paralysis or sensory disturbances in the hand area
Furthermore, bleeding into the muscle boxes can lead to what is known as the compartment syndrome. The muscles are packed in groups in firm, non-stretchable skins. In the event of bleeding, the pressure in these envelopes can increase so much that the nerves and muscles suffer permanent damage. Compartment syndrome is an emergency indication for an operation.
The ulna, like the radius, has, like all other so-called tubular bones, a growth plate (Epiphysis). This is where the growth in length takes place. If this area is injured, this can lead to stunted growth.
The bone fracture in the area of the growth plate is divided into Aitken and Salter in childhood.
You can find more illustrated information on the Aitken and Salter classification under our topic Child Bone Fracture.
In addition to these four complications, surgical complications and anesthetic complications are also possible.
Duration of healing
The time it takes for the broken bone to heal completely depends on various factors. Especially affect the exact location of the break as well as the chosen therapy the healing process and thus the duration until healing. As a general rule, after about 6 weeks the bone fracture usually healed completely is. Depending on how old the affected child is, the bone can be completely healed after 3-5 weeks. It is also true that a Fracture in the center of the bone usually takes longer to heal completely as a break at the ends of the bones.
Depending on the technique used to stabilize and treat the fracture, the arm can be loaded even before the bone finally heals. At a operational care by Intramedullary nails the arm is already Resilient shortly after the operation. Will the break on the forearm with a plaster cast supplied, this must be worn for a few weeks and the Arm can only be loaded after the plaster cast has been removed.
How long does a cast have to be worn?
A popular technique for treating a forearm fracture in children is Application of a plaster cast. Due to the rapid bone healing in children and the general growth in length, a plaster cast is not left in children as long as it is in adults. The duration of the plaster cast on children is on the forearm usually around 3-4 weeks, depending on the age of the child and the individual fracture. At Children over 10 years old the plaster of paris is usually for Leave for 5-6 weeks to ensure safe healing of the affected bone.
Often a few days after the plaster cast has been applied, the cast has to be opened and a new cast must be applied. This depends on the massive swelling of the forearm and wrist related to the violation. If the forearm swells after a few days, the bandage is too loose and no longer fulfills its purpose of immobilization. The other way around The bandage can also be re-applied if it is too tight and causes pressure points. Even if sensory disturbances occur in the fingers, the dressing should be checked and re-applied.
