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Fractures of the forearm and wrist of the child

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Forearm (radius and ulna shaft)

The main complication of these fractures is impaired forearm rotation (pronation: turn the palm downward; supination: turn the palm up). The radius turns around the ulna: therefore,moderate angulations may cause loss of forearm rotation.

These fractures have limited capacity of remodeling; hence, angles above 10-15 ° , according to age and location, are not acceptable.

Treatment depends on the degree of displacement and age:

  • Brachial circular plaster (stable fractures)
  • Elastic intramedullary needles of Metaizeau (Fig 21A)
  • Plate-screws (adolescents) (Fig. 21B)


Figure 21A
. Forearm bones fracture in a patient aged 9, treated surgically with elastic intramedullary needles.


Figure 21B
. Forearm bones fracture in a patient aged 14, fixed with plate and screws.

Fractures of the distal radius and ulna

  • Buckle fractures of the radius  (Fig 3)

Stable fracture. Both the forearm splint and the conventional bandage for 2-3 weeks are effective for pain control (antialgic action).

  • Metaphyseal fractures of the radius + / - ulna
  • The tolerable deformity depends on the age and the proximity of the fracture to the physis.
  • Closed reduction is performed under sedation, followed by immobilization in a brachial circular plaster for 4-6 weeks.
  • Remodeling capacity is 10 ° per year of growth (Fig 7A). If they are very unstable, they may require Kirschner wire fixation (Fig 21C).


Figure 21C
. Fracture of the distal radius and ulna, reduced in OR, and fixed with Kirschner wires.

In physeal fractures, given the high capacity of bone emodeling, reduction maneuvers are not recommended 10-14 days post-fracture, owing to the high risk of physeal damage (Fig 2).

In ulnar physeal fractures, there is a high incidence of premature physeal closure (30-50%), so they must be strictly controlled.

Scaphoid fractures   (Fig 22)  

Unlike adults, scaphoid fractures usually join without problems, and do not require surgical treatment. Cast immobilization is usually prolonged.


Figure 22
. Scaphoid fracture in an adolescent

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