Forearm fractures in children

Forearm fractures are among the most frequent fractures in childhood. They can involve the radius, the ulna or both bones. In children, complete fractures, greenstick fractures, plastic deformations or fractures close to the wrist and elbow may be seen.

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If the ER suggested a paediatric orthopaedic check-up

It is a frequent and reasonable indication. After the first urgent assessment, a paediatric orthopaedic visit helps to read the X-rays together, understand what was seen, plan any follow-ups and answer the questions that come up at home — about the cast, sleep, school, sport and the next steps.

You are not alone in this: bringing the ER paperwork and the X-rays is already a good start.

The forearm has a particular function: it not only supports the arm but allows rotation of the hand, namely pronation and supination. For this reason, in radius and ulna fractures what matters is not only healing but also that alignment allows good recovery of rotation.

They are common in school age and adolescence, often after falls on the hand, sports trauma, bicycle, scooter or play activities.

In case of visible deformity, severe uncontrolled pain, cold or pale fingers, sensory changes, open wounds or major trauma, urgent ER care is required.

🩺Clinical note

In paediatric fractures it is not only about whether a bone is broken: site of the lesion, growth plate involvement, the child's age and remodelling potential all shape the follow-up plan.

Why they deserve careful evaluation

Both-bone forearm fractures may require non-short healing times and serial check-ups, especially if the fracture is unstable or alignment is not optimal. In some cases conservative treatment is appropriate, but when alignment is not satisfactory or the fracture tends to displace, surgical stabilisation can also be considered.

This does not mean every forearm fracture has to be operated. It means that in children the decision must be individualised, taking into account age, location, rotation, displacement, stability and remodelling potential.

Monteggia-type lesions are a particular topic: an ulna fracture combined with a problem of radial head alignment at the elbow. Correct recognition is crucial because inadequate treatment may leave important functional limitations.

Possible aspects to check

radius and ulna alignment
forearm rotation
stability of the reduction at follow-up
relation to wrist and elbow
possible Monteggia or Galeazzi pattern
recovery of pronation and supination
persistent pain or limitation

Aspects assessed during a paediatric orthopaedic visit. They are not self-management criteria.

Paediatric orthopaedic check-up after trauma or fracture

Dr. Daniele Priano sees children and adolescents in Milan. The visit can be useful after the ER, X-rays, a cast, sports trauma or questions about the follow-up pathway.

Book a paediatric orthopaedic check-up See locations and booking

Content for general informational purposes only. It does not replace a medical evaluation.