Hand, Wrist, and Forearm Fractures in Children

What it is

Children's bones are softer and more flexible than adults', like fresh wood compared with dry. They can bend without breaking (greenstick fracture) or partly crumple (buckle fracture). They also have growth plates, softer bands of cartilage near the ends of bones that let them grow. Growth plates are weaker than bone and are a common site of fractures.

What causes it

Falls while running, jumping, or climbing; sports injuries such as a ball bending a finger back; and fingertips crushed in doors.

When to seek care

Go to an emergency room if a finger, wrist, or forearm looks crooked or there is a deep, bleeding wound. Not every fracture looks crooked; significant swelling, bruising, an injured nail, or pain and stiffness that persist call for an X-ray. A hairline fracture through a growth plate can look normal on X-ray.

Treatment

Most children's fractures heal quickly, often in three to four weeks, and most are treated with a cast, splint, or brace. Fractures that are out of position may need to be set, and some need pins, screws, or plates. Growth plate fractures should be diagnosed promptly so they can be realigned, if needed, before they start to heal.

Prevention

Keeping fingers away from closing doors and exercise equipment, wearing wrist guards and the right sports equipment, and adult supervision can help prevent some injuries.

Recovery

After healing, children's bones gradually reshape themselves (remodeling), so a fracture that heals slightly bent can straighten over weeks or months, especially in younger children. Fractures bent in the direction the joint moves remodel best. Fractures into a joint, or those that are rotated or angled sideways, remodel poorly and need more precise realignment, sometimes with surgery. Most growth plate fractures heal without affecting growth. Growth plates close at around 14 in girls and 16 in boys.