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Forearm Fractures


The forearm has 2 bones – one is called the radius (on the same side of the forearm as the thumb) and the other is the ulna (on the same side of the forearm as the small finger). Forearm fractures can occur anywhere in these bones, from the elbow to the wrist, and may even be associated with a dislocation (when a bone pops out of a joint). Forearm fractures often occur through the growth plate, which is made of cartilage, because the cartilage is weaker than the bone.
Children love to play and run, and this can lead to a child falling onto their arm, leading to a fracture. Forearm fractures are the most common fractures in children (up to 50% of all fractures in children!) and occur in 1 out of every 100 children. The vast majority of these fractures can be treated with just a cast or splint, although some of them may need to be reset to improve the alignment of the bones.

Types of fractures

Physeal (Growth Plate) fracture:
This occurs when the growth plate or physis through the wrist is involved in the injury. These fractures are especially common near the wrist.  There is a large amount of remodeling potential when fractures occur near or through physis, especially in younger children.
Growth Plate Fracture
X-ray example of a growth plate fracture (red arrow) at the wrist.

Torus or buckle fracture:
This occurs when only one side of the bone is compressed and buckles but does not break all the way through. This is like when you push down on an empty paper towel roll and the roll buckles but does not break. The other side of the same bone is not affected.
Buckle Fracture
X-ray example of a torus or buckle fracture (red arrows) of the wrist (AP).
Buckle Fracture
X-ray example of a torus or buckle fracture (red arrows) of the wrist (Lateral)
Greenstick fracture:
This occurs when one side of the bone breaks but the other side of the bone is simply bent (red arrows). This is occurs because children’s bones are still very soft compared to adult bones.

Plastic deformation fractures:
This occurs when the bones bend but do not break. Many times you cannot see a break on the x-ray but the bones may look bowed. Again, this occurs in children only because their bones are still very soft.

Figure: X-ray example of plastic deformation. The bones in the forearm are bowed but not broken.
X-ray example of plastic deformation. The bones in the forearm are bowed but not broken.
Complete fractures:
This is when the bones are completely separated and not touching on the x-ray.
Forearm Fracture
X-ray example of complete fractures of the radius and ulna

Monteggia fractures:
This occurs when the ulna has a fracture and the radial head (the part of the radius near the elbow) has dislocated from the elbow joint.
Monteggia Fracture
X-ray example of Monteggia fracture. The ulna is broken and the radial head is dislocated at the elbow (red arrow)
Figure: X-ray example of Monteggia fracture. The ulna is broken and the radial head is dislocated at the elbow (red arrow).
Galeazzi fracture:
This injury involves a fracture of the radius and the ulna is dislocated at the wrist.
In a Galeazzi fracture-dislocation, the radius is fractured (red arrow), and the wrist is dislocated (red circle).


A crooked arm, swelling, pain, an inability to move the arm, and bruising are the most obvious signs that there is a fracture. In severe injuries, the skin near the bone may have an open wound with bleeding. If that happens, this is an emergency, and you should bring your child to the emergency room to prevent the bone from getting infected. Severe injuries may also be accompanied by numbness and tingling in the hand or forearm.  You should bring your child to the emergency room if that happens. Pain that does not get better on its own may also be a sign of a fracture, even if the arm does not look crooked.


The doctor will carefully look at the skin around the elbow, forearm, and wrist as well as touch those areas to see what hurts. He or she may also try to gently move the joints. Testing the nerves and circulation to the hand are also important.

Other Tests

Most of the time, simple x-rays are all that are needed to diagnose a forearm fracture. Because forearm fractures can be associated with fractures of the wrist and elbow, your doctor will usually obtain x-rays of those areas as well.


The vast majority of forearm fractures can be treated without surgery. Stable fractures such as a buckle or torus fracture can generally be treated in a splint or cast for 3 to 4 weeks. If the bones are angled, the doctor may need to reset the bones to get a better alignment and then put a cast on to hold the bones in place while they heal. Depending on how great the deformity is, this manipulation may occur in the clinic, under sedation in the emergency room, or even in the operating room. In young children, some angulation and displacement is often acceptable because of rapid healing and reliable remodeling. Many times your child will need to come back for a repeat x-ray in 7 to 10 days to make sure that the bones stay in a good position. Most forearm fractures require a cast for at least 6 weeks, and sometimes even for 12 weeks depending on the severity of the fracture and how well it is healing. Sometimes at the 6 week mark, the long arm cast can be changed to a shorter cast.

Surgical Treatment

Surgery may be needed in some circumstances:
  • There is a cut in the skin near the broken bone
  • The bones will not stay lined up even in a cast
  • The bones have started to heal in a bad position and cannot be manipulated because of the healing.
  • The injury is closer to the elbow and the bones are not well aligned
Different types of implants may be used in surgery to keep the bones aligned. This may include temporary pins or plates and screws. After surgery, a cast or splint may still be used to help keep the bones in place during healing.


Fractures near wrist generally have rapid healing and injuries near middle of forearm may take longer to heal and have higher chance of re-fracture. Stiffness in the elbow and/or wrist is common after coming out of the cast or splint. This usually gets better on its own after a few weeks, but in rare cases, physical therapy is needed to help regain motion. Because the bones are still weak after getting out of the cast, your doctor may recommend that your child avoids sports and physical education for 4 to 6 weeks afterwards to prevent the bone from re-breaking if your child falls onto the arm. If the fracture involves the growth plate, your doctor may want to repeat the radiograph in 6 to 12 months to make sure the bone is still growing normally.

More Information


Q. Is a fracture the same as a break?

Yes, a fracture is a break in the bone.

Q. How come the fracture was not initially seen on the XR?

Fractures that occur in the growth plate are not able to be seen on XR until there is healing and new bone formed in 3-4 weeks after the injury. Your doctor may diagnose a subtle fracture in your child if there is localized pain, tenderness, and swelling around the growth plate, even if there is not a fracture seen on the XR.
Forearm fractures that have plastic deformation occur when the bones have bent but there is not a break. The bones look bent on the XR but there is no fracture that is seen.

Plastic deformation after a twisting injury. The forearm bones are bowed but there is no fracture.

Q. How come the bones still look a little crooked to me on the X-ray but the doctor says they are okay?

Children have the ability to straighten out their bones as they grow. This is known as bone remodeling. Certain amounts of crookedness are okay, depending on the age of your child and where the fracture is.
Evidence of remodeling 4 months after the cast was taken off.

Q. How come even after putting on a cast, the bones changed position when we got another x-ray 10 days later?

As the swelling in your child’s arm goes down, the cast does not shrink with the arm. This leaves some space in the cast that may allow the bones to shift, depending on the pattern of the fracture. Because of this, the cast may need to be changed in the first few weeks.

Q. Will my child need surgery?

That depends on the pattern of the fracture as well as your child’s age. As long as your child is still growing, the mainstay of treatment is generally to try a cast first. 

Q. After the bone has healed, will it hurt when it is cold or it rains?

Unless you child needs permanent hardware to keep their bones straight, the answer is no.

Q. Will my child get arthritis from having this fracture?

Arthritis only occurs in joints, and the vast majority of forearm fractures do not involve the joints. So, for almost all forearm fractures, the answer is no.

Q. Why can’t my child play sports with the cast on?

The risk of injuring the original fracture or a causing new fracture is very low after early healing while in the cast. Sometimes sports are restricted to protect the cast or other people. Most young children will be very active in the cast!

Q. Does this fracture put my child at risk for re-breaking the bone in the future?

Once the bone fully heals, the answer is no. This is why your doctor may still restrict your child from activities once the cast comes off. It may take 3 or 4 months for the bone to fully regain its strength.

Q. Does my child need to take supplements/vitamins/drink milk to heal their fracture?

No. There is no scientific evidence to support that any of these things will heal a fracture faster. However, it is always a good idea to make sure your child has a healthy, balanced diet.