Broken Arms in Children | Boston Children’s Hospital

How is a broken arm diagnosed?

The doctor will carefully examine your child’s arm looking for symptoms of a fracture. The doctor may also order one or more of the following imaging tests to help them see signs of a broken bone as well as damage to nearby muscles or blood vessels:

• X-ray: The main tool used for diagnosing a broken bone. This painless test uses small amounts of radiation to produce images of bones onto film. X-rays can also help determine whether the bones in the arm are healing in the proper position.
• Magnetic resonance imaging (MRI): A diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body. MRIs are more sensitive than x-rays and can pick up smaller fractures before they get worse.
• Computed tomography scan (CT, CAT scan): A diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body.
• Bone scan: A painless imaging method that uses a radioactive substance to evaluate bones and determine the cause of pain or inflammation. Bone scans are also useful for detecting stress fractures and toddler’s fractures, which can be hard to see on x-rays.

How is a child’s broken arm treated?

Treatment for a broken arm depends on the specific location and severity of the break, your child’s age, overall health, and medical history.

Non-surgical treatments for a broken arm

Casts and splints

Splints and casts immobilize injured bones to promote healing and reduce pain and swelling. They are sometimes put on after surgical procedures to ensure that the bone is protected and in the proper alignment as it heals.

Splints are used for minor breaks. Splints support the broken bone on one side and immobilize the arm to promote bone alignment during healing. Splints are often used in emergency situations to hold a joint in a steady position while a child is transported to a medical facility.

Casts are stronger than splints and provide more protection to the injured area. They hold a broken bone in place while it heals by immobilizing the area above and below the joint.

Some common types of casts for broken arms include:

• Short arm casts extend from the elbow to the hand and are used for forearm or wrist fractures or to hold the arm in place after surgery.
• Long arm casts extend from the upper arm to the hand and are used for upper arm, elbow, or forearm fractures. They are also used to hold the arm in place after surgery.
• Arm cylinder casts extend from the upper arm to the wrist and are used to hold the elbow muscle and tendons in place after a dislocation or surgery.

Traction and closed reduction

Traction corrects broken or dislocated bones by using a gentle and steady pulling motion to stretch muscles and tendons in a specific direction around the broken bone. This allows the bone ends to align and heal, and in some cases, it reduces painful muscle spasms.

Closed reduction is a nonsurgical procedure used to reduce and set the fracture. Using an anesthetic (typically given through an IV in the arm), the doctor realigns the bone fragments from outside the body and holds it in place with a cast or splint.

Surgical treatment for a broken arm

Surgery may be needed to put broken bones back into place. A surgeon may insert metal rods or pins located inside the bone (internal fixation) or outside the body (external fixation) to hold bone fragments in place to allow alignment and healing. This is done under general anesthesia.

Adult Forearm Fractures – OrthoInfo

Your forearm is made up of two bones: the radius and ulna. In most cases of adult forearm fractures, both bones are broken.

Fractures of the forearm can occur near the wrist at the farthest (distal) end of the bone, in the middle of the forearm, or near the elbow at the top (proximal) end of the bone. This article focuses on fractures that occur in the middle segments of the radius and ulna. Fractures that involve the wrist or the elbow are discussed in separate articles.

If you hold your arms at your side with your palms facing up, the ulna is the bone closest to your body and the radius is closest to your thumb. The ulna is larger at the elbow — it forms the point of your elbow — and the radius is larger at the wrist.

Illustration showing the long bones of the forearm, the radius and the ulna.

The primary motion of the forearm is rotation: the ability to turn our palms up or down. The ulna stays still while the radius rotates around it. This is the motion used to turn a screwdriver or twist in a light bulb. Forearm fractures can affect your ability to rotate your arm, as well as bend and straighten the wrist and elbow.

Forearm bones can break in several ways. The bone can crack just slightly, or it can break into many pieces. The broken pieces of bone may line up straight or may be far out of place.

In some cases, the bone will break in such a way that bone fragments stick out through the skin or a wound penetrates down to the broken bone. This is called an open fracture and requires immediate medical attention because of the risk for infection.

Because of the strong force required to break the radius or ulna in the middle of the bone, it is more common for adults to break both bones during a forearm injury. When only one bone in the forearm is broken, it is typically the ulna — usually as a result of a direct blow to the outside of your arm, such as when you have it raised in self defense.

Illustration and X-ray showing fractures of both the radius and ulna.

Alternatively, one bone may break while ligaments at either the elbow or wrist are torn, resulting in a joint dislocation at the elbow or wrist in addition to the fracture. These injuries, which are less common than breaking both bones, have specific names: Monteggia and Galleazi injuries.

The most common causes of forearm fractures include:

• Direct blow
• Fall on an outstretched arm, often during sports or from a height
• Automobile/motorcycle accidents

A broken forearm usually causes immediate pain. Because both bones are usually involved, forearm fractures often cause an obvious deformity — your forearm may appear bent and shorter than your other arm. You will most likely need to support your injured arm with your other hand.

Additional symptoms include:

• Swelling
• Bruising (not as common as in other broken bones)
• Inability to rotate arm
• Numbness or weakness in the fingers or wrist (rare)

Most people with forearm fractures will need to seek immediate treatment.

Physical Examination and Medical History

It is important that your doctor knows the circumstances of your injury. For example, if you fell from a ladder, how far did you fall? It is just as important for your doctor to know if you sustained any other injuries and if you have any other medical problems, such as diabetes. Your doctor also needs to know if you take any medications.

After discussing your symptoms and medical history, your doctor will do a careful examination. Your doctor will:

• Examine your skin to see if there are any cuts from the injury. Bone fragments can break through the skin and create lacerations. This leads to an increased risk for infection.
• Palpate (feel) all around your arm to determine if there are any other areas of tenderness. This can indicate other broken bones or injuries.
• Check your pulse at the wrist to be sure that good blood flow is getting through your forearm to your hand.
• Check to see if you can move your fingers and wrist, and can feel things with your fingers. Sometimes, nerves may be injured at the same time that the bone is broken, which can result in hand and wrist weakness and numbness.

The doctor may examine your shoulder, upper arm, elbow, wrist, and hand, even if you complain only of arm pain.

X-rays

X-rays can show whether the bone is broken and whether there is displacement (the gap between broken bones). They can also show how many pieces of broken bone there are.

Treatment of broken bones follows one basic rule: The broken pieces must be put back into position and prevented from moving out of place until they are healed. Because the radius and ulna rely on each other for support, it is important that they are properly stabilized. If the bones are not accurately aligned during healing, it may result in future problems with wrist and elbow movement.

Most cases of adult forearm fractures require surgery to make sure the bones are stabilized and lined up for successful healing.

Immediate Treatment

While you are in the emergency room, the doctor may try to temporarily realign the bones, depending on how far out of place the pieces are. Reduction is the technical term for this process in which the doctor moves the pieces into place. This is not a surgical procedure. Your pain will be controlled with medication. Afterward, your doctor will apply a splint (like a cast) to your forearm and provide a sling to keep your arm in position. Unlike a full cast, a splint can be tightened or loosened, and allows swelling to occur safely.

The emergency room doctor may apply a splint to protect your arm.

Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

It is very important to control the movement of a broken bone. Moving a broken bone can cause additional damage to the bone, nearby blood vessels, and nerves or other tissues surrounding the bone.

Additional immediate treatment will include applying ice to help reduce swelling, and providing you with pain medication.

Nonsurgical Treatment

If only one bone is broken and it is not out of place, it may be possible to treat it with a cast or brace. Your doctor will closely monitor the healing of the fracture, and have you return to the clinic for X-rays frequently. If the fracture shifts in position, you may require surgery to put the bones back together.

Surgical Treatment

When both forearm bones are broken, or if the bones have punctured the skin (open fracture), surgery is usually required.

Because of the increased risk for infection, open fractures are usually scheduled for surgery urgently. Patients are typically given antibiotics by vein (intravenous) in the emergency room, and may receive a tetanus shot. During surgery, the cuts from the injury will be thoroughly cleaned out. The broken bones are typically fixed during the same surgery. In severe open injuries, multiple operations may be required to adequately clean the injured soft tissues.

If the skin around your fracture has not been broken, your doctor may recommend waiting until swelling has gone down before having surgery. Keeping your arm immobilized and elevated above the level of your heart for several days will decrease swelling. It also gives skin that has been stretched a chance to recover.

Open reduction and internal fixation with plates and screws. This is the most common type of surgical repair for forearm fractures. During this procedure, the doctor first repositions (reduces) the bone fragments into their normal alignment. The bones are held together with special screws and metal plates attached to the outer surface of the bone.

The broken bones of the forearm are held in position by plates and screws while they heal.

Open reduction and internal fixation with rods. During this procedure, the doctor inserts a specially designed metal rod through the marrow space in the center of the bone.

External fixation. If the skin, muscles, and bone are severely damaged, using plates and screws and large incisions may injure the skin further. This may result in infection. In this case, you may be treated with an external fixator. In this type of operation, the doctor places metal pins into the bone above and below the fracture site. The pins and screws are attached to a bar outside the skin. This device is a stabilizing frame that holds the bones in the proper position so they can heal.

Complications from Forearm Fractures

Complications can arise from both operative and non-operative treatment of forearm fractures in adults:

• The ends of broken bones are often sharp and can cut or tear surrounding blood vessels or nerves.
• Excessive bleeding and swelling right after the injury may lead to compartment syndrome, a condition in which the swelling cuts off blood supply to the hand and forearm. It typically occurs within 24 to 48 hours of the injury and causes severe pain when moving the fingers. Compartment syndrome can result in loss of sensation and function, and requires emergency surgery once it is diagnosed. In such cases, the skin and muscle coverings are opened and left open to relieve pressure and allow blood to return.
• Open fractures expose the bone to the outside environment. Even with good surgical cleaning of the bone and muscle, the bone can become infected. Bone infection is difficult to treat and often requires multiple surgeries and long-term antibiotics.

Complications from Surgery

There are risks associated with all surgery. If your doctor recommends surgery, they believe that the possible benefits of surgery outweigh the risks.

• Infection. There is a risk of infection with any surgery, whether it is for a forearm fracture or another purpose.
• Damage to nerves and blood vessels. There is a minor risk of injury to nerves and blood vessels around the forearm. Although some temporary numbness is common right after your injury, if you experience persistent numbness or tingling in your fingers, contact your doctor.
• Synostosis. Another rare complication is healing between the two bones of the forearm with a bridge of bone known as synostosis. This can decrease the rotation of the bones and prevent full movement.
• Nonunion. Surgery does not guarantee healing of the fracture. If the fracture fails to heal, you may need further surgery.
• A fracture may pull apart, or the screws, plates, or rods may shift or break. This can occur for a variety of reasons, including:
  • The patient does not follow directions after surgery.
  • The patient has other health issues that slow healing. Some diseases, like diabetes, slow healing. Smoking or using other tobacco products also slow healing.
  • If the fracture was associated with a cut in the skin (an open fracture), healing is often slower.
  • Infections can also slow or prevent healing.
• Stiffness. Depending on the severity and location of your fracture, you may develop elbow or wrist stiffness. you may lose the ability to fully rotate your palm up and down.
• Bothersome or painful implants. Theplates placed on the bones may cause discomfort, especially when they are placed on the border of the ulna, which is just underneath the skin. Once the fracture has healed, symptomatic plates may be removed later.

The most common complication during non-operative treatment is loss of reduction. This means that the bone ends at the fracture site move away from each other. This may require an operation. If you continue with non-operative management, you may experience stiffness with limited ability to rotate your palm up and down.

Bones have a remarkable capacity to heal. Forearm bones typically take 3 to 6 months to fully heal. The more severe your injury, however, the longer your recovery may be.

Pain Management

Pain after an injury or surgery is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover faster.

Medications are often prescribed for short-term pain relief after surgery or an injury. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.

Be aware that although opioids help relieve pain after surgery or an injury, they are a narcotic and can be addictive.  It is important to use opioids only as directed by your doctor and stop taking them as soon as your pain begins to improve. Talk to your doctor if your pain has not begun to improve within a few days of your treatment.

NSAIDs may reduce the body’s ability to heal a fracture. Consult with your surgeon before taking NSAIDs if you have a fracture.

Rehabilitation

Nonsurgical treatment. Rehabilitation typically begins after a few weeks of keeping the arm still by using a cast or brace. In many cases, a physical therapist will help with rehabilitation, beginning with gentle exercises to increase range of motion and gradually adding exercises to strengthen the arm.

Surgical treatment. Depending on the complexity of the fracture and the stability of the repair, you may need a cast or brace for 2 to 6 weeks after surgery. You will usually begin motion exercises for the forearm, elbow, and wrist shortly after surgery. This early motion is important to prevent stiffness. Your doctor may also prescribe visits to a physical or occupational therapist, depending on how long your arm was immobilized.

Outcome

Some stiffness after healing is common, but this does not usually affect the overall function of your arm.

Your doctor will advise you on when you may return to work and sports activities. This varies depending on the fracture pattern and the type and stability of the repair.

If you have had surgery, the plates and screws are usually left in place forever. If you consider removal, this second surgery is typically not scheduled until your bones have fully solidified (1 to 2 years after initial surgery).

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signs, symptoms, diagnosis and treatment in Moscow at the Center for Surgery “SM-Clinic”

General information

Kinds

Symptoms

Diagnostics

Operations

Expert opinion of a doctor

Rehabilitation

Question answer

General information

A fracture of the arm is understood as a violation of the integrity of one or more bones, which is accompanied by the formation of two or more bone fragments. The condition is characterized by severe pain, swelling at the site of injury.

The cause of a broken arm can be both external factors (accident, fall, impact), and physiological changes in the body itself (oncological processes, some infectious diseases, genetic abnormalities).

Species

Symptoms

Diagnosis

Preliminary diagnosis of arm fracture is based on clinical symptoms. During a visual examination, the traumatologist finds out the nature and circumstances of the injury, plans further examination and treatment.

Additional diagnostic measures are:

• conducting radiography with multiple projections;
• taking laboratory tests to assess the general condition;
• Examination with computed tomography or magnetic resonance imaging in difficult cases.

Hand fracture surgery

Conservative tactics are indicated only for stable isolated fractures without displacement and complications. As for other types of injuries, there are several options for surgical treatment of injuries of the upper extremities in the arsenal of orthopedic traumatologists.

Bone grafting

The procedure is an open surgical intervention, during which the damaged bone areas are removed, and analogues are installed in their place. The material is healthy tissues of the patient or a donor and artificial substitutes from biosynthetics.

Osteosynthesis

The technique involves the connection of bone fragments with special fixators, which provide reliable immobilization of the bone in the desired position.

More

Open or closed bone reduction

During such an operation, bone elements are manually or with the help of devices connected in the desired position, after which an external fixator is applied to ensure the immobility of the hand.

More

The choice of surgical treatment depends on the type of fracture, the complexity of the injuries, the age of the patient and his general health.

Medical expert opinion

Rehabilitation

Question-answer

In most cases, with timely access to qualified medical care, the functions of the hand are restored in full.

The terms are different, it all depends on the severity of the injuries and the individual characteristics of the health of a particular patient. For some, 2-3 months is enough for recovery, others are forced to wear a retainer for six months.

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Fracture of the radius with displacement

Full recovery after a fracture of the radius consists in restoring the structure of the bone, the function of the limb (mobility and sensitivity). Even with absolutely adequate treatment, prolonged immobility in the joints and muscles of the upper limb makes it difficult for the patient to make movements in the joints that were previously accessible to him. The recovery process after an injury takes a long time, requires the patient to be patient and willing to work.

Rehabilitologists at the Yusupov hospital begin to develop joints and muscles in case of a fracture of the radius as early as possible. The timing of the start of rehabilitation measures depends on the type of fracture, the method of treatment. If the fracture is treated conservatively, then after 3-5 days, after the edema subsides, they begin to deal with the fingers of the hand.

Perform passive movements first. They take a finger on a broken limb with a healthy hand and gently begin to bend it in all joints. In this way, knead for 5-7 minutes 3 times a day, all fingers, except for the thumb. After a week of such training, they move on to active movements. The patient can begin independently, without the help of the second hand, to bend the fingers. It is very important to properly distribute the load. If during the exercise pain occurs or swelling reappears, the exercise should be stopped.

Simultaneously with the beginning of passive movements in the fingers, active movements in the elbow and shoulder joints begin. The patient raises and lowers his arm, bends it at the elbow. Do these exercises for 3-5 minutes at least 2 times a day, gradually increasing the load. After 3-4 weeks, if active movements of the fingers of the hand do not cause pain, they begin to increase the load on these joints. You need to take a lump of plasticine and knead it in your fist. This exercise should be done as often as possible, during the week. After removing the plaster, proceed to exercises with a carpal expander. You should do at least three times a day for 5-7 minutes.

Physical therapy instructor teaches patient fine motor skills. By the end of the fourth week, the patient may begin to draw or write with the affected hand. You can sort out one grain of rice or buckwheat. This will preserve not only the strength and mobility of the joints, but also the coordination of the movements of the fingers. You can type texts on the computer keyboard as an exercise in coordination. If the patient does exercises at the time when he has a plaster splint installed, then after its removal, the rehabilitation period will be significantly reduced.

Exercises should include all articular joints of the injured limb. It is important to stretch your fingers regularly. To relieve tension in the affected limb, some exercises after removing the plaster cast should be carried out in the water. The duration of the course of physiotherapy exercises is determined by the rehabilitators of the Yusupov hospital individually. The average duration of a course of therapeutic exercises is 1.5 months.

Rehabilitators teach patients exercises that can be done at home. Water gymnastics involves performing simple physical therapy exercises in water. Classes can be held in the bathroom. Cosmetic sea or edible salt should be added to warm water. It will make the exercise process easier.

The complex consists of the following exercises:

9012 8

The duration of the procedure is from 10 to 15 minutes.