Surgery · Fractures

Forearm fractures: when ESIN changes the story

The forearm doesn't just support the hand: it rotates it. That is why, in radius and ulna fractures, alignment matters as much as bone healing.

A forearm that heals in an incorrect position can lead to deformity or functional limitation. In children, many deformities correct spontaneously with growth, while others require specific treatment.

The two main routes

Conservative treatment

Closed reduction and an above-elbow cast. Works well for mildly displaced or stable fractures and in young children with high remodelling potential. Requires close X-ray follow-up to catch any re-displacement.

Surgical fixation

Needed when alignment is unsatisfactory, when the fracture is unstable, or when age no longer allows reliance on remodelling. The most common techniques are radius/ulna ESIN or, in selected cases, plate and screws.

Typical surgical procedures

ESIN — elastic intramedullary nailing of radius and/or ulna

One or two elastic nails are inserted into the bone canal through small incisions. Closed reduction is attempted to preserve surrounding tissues; the fracture site may need to be exposed if this cannot be achieved.

Both-bone forearm fractures in school-age children and adolescents, unstable or poorly reducible fractures.

Both bones are often stabilised together. The nails are removed in a planned second operation once healing is complete.

Percutaneous K-wires

Percutaneous stabilisation for distal radius fractures close to the wrist.

When the site is very distal and ESIN is not the most suitable option.

Plate and screws

More rigid fixation reserved for selected cases, typically adolescents near skeletal maturity or complex fractures.

Failure or non-indication of ESIN, multifragmentary fractures, some revisions.

Watch out for Monteggia lesions

An ulnar fracture can be associated with malalignment of the radial head at the elbow (Monteggia lesion). Recognising it on time changes the prognosis: a missed Monteggia is a classic problem that shows up later as elbow dysfunction.

What changes for the child and the family

With ESIN, casting time — when needed — is usually shorter than with conservative treatment alone.
Return of wrist and elbow motion is generally quicker, but always gradual.
In our practice, elastic nails are generally removed after about 6–12 months, once adequate healing has been documented. The precise timing is individualised according to fracture site, age, radiographic healing and the specific case.
X-ray check-ups verify alignment, rotation and healing progression.

Other fracture sites

Wrist Elbow Humerus Femur Knee Leg Ankle Foot

For parents

Paediatric forearm fractures: information page

Context, checklist of clinical aspects and what to expect after the ER.

A second opinion on a paediatric fracture

Bring the ER report and the X-rays. A focused paediatric orthopaedic visit can clarify indication, timing and alternatives.

Book a visit

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