Video transcript

Let’s talk through your child’s forearm fracture and what you can expect during recovery.

In children, forearm fractures are common — and thankfully, usually less severe than in adults. Children’s bones are softer and more flexible, which means the bone doesn’t always break all the way through. Instead, it may bend or crack on one side while staying intact on the other. These are known as buckle fractures or greenstick fractures, and they tend to heal well without long-term problems.

In some cases, the bone does break completely. The forearm has two bones — the radius and the ulna. Sometimes only one is broken, but in other cases, both are affected. The breaks can happen at the same level or at different levels — with one closer to the elbow and the other nearer the wrist.

Some of these fractures can look quite deformed at the time of injury, especially if the arm is bowed or twisted. In adults, we would usually need surgery to fix this. But in children, the bones can straighten themselves out over time as they grow. This is called remodelling. The younger the child, the more remodelling potential they have. So in younger children, we can often accept more angulation or deformity and still treat it in a cast. In older children and teenagers, the bones are closer to being fully grown, so we have to be more precise about how straight the bones are at the start.

Treatment depends on a few factors — the type of fracture, how much the bones have moved, and the age of the child.

Minor or incomplete fractures, like buckle fractures, can often be treated with a soft splint for a few weeks. In some cases, these can be removed at home without needing another appointment. For complete or more unstable fractures, we usually use an above-elbow plaster cast, which holds the wrist and elbow still. This cast is typically worn for three to four weeks.

When the fracture is complete, we’ll usually arrange follow-up appointments with X-rays to make sure the bones are healing in the right position. The first two weeks are the highest risk for any movement or shifting of the bone, so that’s when close monitoring is most important. While in the cast, it’s helpful to keep the fingers and shoulder moving to avoid stiffness and keep the child confident using the arm.

If there’s an obvious deformity at the start, we might manipulate the bone back into position in the emergency department before putting the cast on. If that gives us a good result, we can usually continue without surgery.

However, if the fracture is severely displaced or starts to shift out of place during follow-up, we may recommend a procedure under general anaesthetic. That might be a more accurate manipulation or, if the fracture is unstable, surgical fixation. This could involve flexible rods inserted through small cuts at the wrist or elbow. In older children, we might instead use plates and screws through a small incision over the fracture site.

If flexible rods are used, they usually need to be removed a few months later in a second operation. Plates and screws are often also removed in younger children but may be left in place in older teenagers, depending on the circumstances.

Most children make a full recovery from these fractures. Even if there’s some mild angulation, children’s bones often remodel and straighten out over time. But in the early stages, it’s important to protect the fracture properly, especially while the child is in the first cast. This initial cast is often a backslab, which allows for swelling but isn’t as strong as a full cast.

For complete fractures, we usually perform weekly X-rays in the first two weeks to confirm everything is staying in position. While in the cast, parents should watch out for signs it might be too tight — things like increasing pain, numbness, tingling, or changes in finger colour. If that happens, the child should be brought back to the emergency department so the cast can be checked or adjusted.

There is one rare but serious complication called compartment syndrome. This is where swelling builds up in the muscles and causes pressure that can affect blood flow and nerves. It’s uncommon but more likely in high-energy injuries or very deformed fractures. If there’s a concern, your child may be admitted for observation.

If your child does have metalwork inserted during surgery, we’ll discuss early on whether a second operation will be needed to remove it. The timing and need for removal depends on the type of metalwork and your child’s age.

In general, healing is fast. If the fracture was treated in a cast without surgery, it’s usually removed after three to four weeks once there’s clear healing. Most children can be discharged from clinic at that point without needing further scans.

Children can return to day-to-day activities like writing and eating as soon as they feel ready. But for sports and heavier activities, we usually recommend waiting another three to four weeks to reduce the risk of re-injury. After that, a gradual return is usually fine.

For children who had surgical fixation, the recovery plan will be tailored by the operating team, depending on what was done. Flexible nails will be scheduled for removal after a few months. Plates and screws might be removed in future or left in place, depending on the child’s age.

Overall, these injuries heal very well. Even when the bone isn’t perfectly straight at the start, most children regain full function with no long-term issues.