Complications of forearm fractures in children | Forearm fracture in a child

Complications of forearm fractures in children

As with all injuries, forearm fractures can also cause complications. Four complications are highlighted for children. Since children are treated conservatively and surgery is avoided where possible, the bone can break again at the already injured site if the load is applied too early.

This is less common with fractures secured with plates. The second complication is the long-term restriction of forearm movement. The forearm, which consists of ulna and radius, is actually a joint that the rotational movement of the hand leads to a movement of the forearm bones.

In the case of poorly healed fractures, this movement may be restricted. The third complication is soft tissue damage. This includes bleeding into the muscle or damage to the nerves and vessels.

Damage to the nerves can lead to permanent paralysis or sensory disturbances in the area of the hand Furthermore, bleeding into the muscle lobe can lead to the so-called compartment syndrome. The muscles are wrapped in groups in firm, non-stretchable skins. If there is bleeding, the pressure in these skins can increase so much that nerves and muscles suffer permanent damage.

Compartment syndrome is an emergency indication for surgery. The ulna, like the radius, has a growth plate (epiphysis), like all other so-called tubular bones. This is where the longitudinal growth takes place.

If this area is injured, this can lead to growth disorders. The bone fracture in the area of the growth plate is divided into Aitken and Salter in childhood. More illustrated information on the Aitken and Salter classification can be found under our topic Childhood bone fracture. In addition to these four complications, surgical complications, anaesthetic complications are also possible.

Duration of healing

The time it takes for the fracture to heal completely depends on various factors. In particular, the exact location of the fracture as well as the chosen therapy influence the course of healing and thus the duration until healing. In general, the fracture is usually completely healed after about 6 weeks.

Depending on how old the affected child is, the bone can also be completely healed after 3-5 weeks. It is also true that a fracture in the middle of the bone usually takes longer to heal completely than a fracture at the bone ends. Depending on the technique used to stabilize and treat the fracture, the arm can be loaded before the bone has healed completely.

In the case of surgical treatment with intramedullary nails, the arm can be loaded shortly after the operation. If the fracture is treated with a plaster cast on the forearm, it must be worn for several weeks and the arm can only be loaded after the plaster cast has been removed. A popular technique for treating a forearm fracture in children is the application of a plaster cast.

Due to the fast bone healing in children and the growth in length in general, a plaster cast is not left in children as long as it is in adults. The duration of a plaster cast on a child’s forearm is normally about 3-4 weeks, depending on the age of the child and the individual fracture. For children over 10 years of age, the cast is usually left in place for 5-6 weeks to ensure safe healing of the affected bone.Often the bandage has to be opened and a new cast put on a few days after the cast has been applied.

This is due to the massive swelling of the forearm and wrist as a result of the injury. If the forearm swells after a few days, the bandage is too loose and no longer fulfils its purpose of immobilisation. Conversely, the bandage should also be reapplied if it is too tight and causes pressure points. Even if sensory disturbances in the fingers occur, the bandage should be checked and reapplied.