Of all the fractures that happen in children, the forearm bones are the most common. This is because it is a natural reaction for children (and adults!) to break a fall by reaching out with their arms. This action tends to make the forearm bear the brunt of the force. Doing this makes the two bones in the forearm, the radius and ulna, prone to fracturing.
Injuries vary in severity, often depending on the nature of the trauma. Sometimes only one of the bones is broken (radius or ulna), sometimes both bones are broken. Sometimes the bone is broken close to the elbow, and sometimes it happens close to the wrist. Children are unique in that their bones are still growing, and doctors are careful to establish whether a fracture has gone through the area that the bone grows from (growth plate).
All fractures are serious, but the way individual forearm fractures are managed depends on the specific type of injury. Some can be treated with a cast, but some may require an operation to fix.
Symptoms
Symptoms of a forearm fracture in children include:
- Pain that occurs suddenly with the injury and persists
- Swelling around the fracture site
- Bruising around the fracture site
- Loss of function in that arm/hand
- Visible deformity in the arm
It is especially important to report symptoms of:
- Broken skin near the fracture
- A pale looking hand in the affected arm
Causes
Forearm fractures in children are almost always caused by some sort of trauma. This generally involves a fall, for instance off a bike or play equipment.
Risk Factors
Being a regular active child is the main risk factor for forearm fractures! They generally happen with trauma from falls.
Investigations
The most common investigation required when trying to diagnose a forearm fracture is X-ray. This shows the bones in the forearm, and can show most fractures quite easily.
Complications
Complications of forearm fractures may include:
- Reduced range of movement in the arm (especially rotation in the forearm)
- Damage to muscles – if there is significant delay in the treatment of certain fractures, the blood supply to the forearm muscles may be compromised, resulting in muscle damage
- Damage to nerves – this is unusual, but may result in numbness, tingling or weakness in the forearm or hand
- Deformity – if the bones do not heal from the fracture in the normal way, there may be a bony bump, or angulation in the bone which requires an operation to correct
Treatment
Most broken forearms in children mend well.
Children’s bones heal faster than adult bones. A growing bone can also straighten itself over time. So a break that would need an operation in an adult can often be treated without one in a child.
Most children do not need surgery
- If the bones are in a good position, the arm is put in a cast. This is usually for four to six weeks.
- If the bones are out of place, the doctor pushes them back into line. The arm is not cut open. Your child will be asleep or sleepy for this, so it does not hurt. Then the arm goes in a cast.
- Your child will have more X-rays in the first two weeks. Bones can move a little inside the cast as the swelling goes down.
A buckle fracture of the wrist is stable and heals well in a removable splint in about three weeks.
Waterproof casts let children bath and swim with the cast on. The bone heals just as well, and children feel more comfortable and itch less.
Some children do need surgery
Surgery is needed when:
- the bones will not stay in a good position
- the break will not hold still
- the skin is broken
- the child is older and has less growing left to do
In surgery the bones are held with bendy metal rods inside the bone, or with a metal plate and screws. In children, the metal is often taken out later.
When the cast comes off
The arm will feel stiff and weak. This is normal. Most children get their movement back on their own in a few weeks, just by using the arm. Most do not need physiotherapy.
Your child will need to wait a bit longer before going back to sport and the monkey bars. Your surgeon will say when.
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Prevention
Protective gear such as padding may prevent these injuries when children are engaged in sporting activities.
References
- Liu DS, Murray MM, Bae DS, May CJ. Pediatric and Adolescent Distal Radius Fractures. Current Concepts and Treatment Recommendations. J Am Acad Orthop Surg. 2024, 32(21), e1079-e1089. PMID 38833725.
- Badhe N, Busby C, See A, Deacon C, Altell T, Ollivere BJ, Marson BA. Waterproof casts for the management of upper limb fractures in children. A systematic review and meta-analysis. Bone Joint J. 2025, 107-B(6), 587-594. PMID 40449894.
F.A.Q. | Frequently Asked Questions
My child’s X-ray says greenstick or buckle fracture. What does that mean?
Children’s bones are soft and bend before they break. A buckle fracture is a crumple on one side of the bone, and a greenstick fracture is a crack on one side with the other side bent. Both are stable and heal quickly, often in a splint or cast for 3 to 4 weeks.
The arm is still a bit bent in the cast. Is that a problem?
Often not. Children’s bones straighten themselves as they grow, so a small bend near the wrist in a young child will correct over the next year or two. The surgeon will say how much bend is acceptable for your child’s age.
Does my child need surgery?
Most do not. Surgery is used for fractures that cannot be held in line in a cast, for older children near the end of growth with a lot of displacement, and for open fractures. It usually means flexible rods inside the bones, which are removed later.
How long until the arm is back to normal?
The cast comes off at 4 to 6 weeks. The arm is weak and a little stiff for a few weeks after that, and most children are fully back to normal by about 3 months without needing physiotherapy.