A pediatric distal radius fracture refers to a break in the radius bone, one of the two long bones in the forearm, specifically near the wrist joint in a child. These wrist fractures are among the most frequent bone injuries observed in children, often resulting from common incidents such as falls. While discovering your child has a fracture can be concerning, these injuries are generally treatable and tend to heal well in children.
Understanding the Injury: What It Is and Why It Happens
The radius is the larger of the two bones in the forearm, extending from the elbow to the wrist. A distal radius fracture occurs when this bone breaks at its lower end, closest to the wrist. In children, these fractures frequently involve the growth plate, also known as the physis, which is a softer area of developing bone near the ends of long bones responsible for bone growth.
Children are particularly susceptible to distal radius fractures due to their active lifestyles and the unique properties of their bones. The most common cause is a fall onto an outstretched hand (FOOSH), which often happens during play, sports, or activities like riding bikes or skateboarding. The forces from such falls can cause the bone to buckle or break.
A common type of distal radius fracture in children is a “buckle” or “torus” fracture. This incomplete fracture occurs when one side of the bone bends and compresses, creating a bulge, but the bone does not break completely through. These fractures are generally stable.
Recognizing the Signs and Diagnosis
Immediately after the injury, the wrist area typically becomes painful, tender, and swollen. In some cases, a visible deformity, where the wrist appears bent or crooked, might be present.
Children with this injury may also resist moving their wrist or show distress when attempting to use their hand. Bruising around the wrist can develop within hours or days following the injury.
A healthcare professional will typically begin the diagnostic process by taking a history of how the injury occurred and performing a physical examination of the wrist, checking for tenderness, swelling, and any visible deformity. X-rays are the primary diagnostic tool used to confirm the presence of a fracture, determine its exact location, and assess if the bone fragments are displaced. In more complex cases, or when growth plate involvement is suspected, a CT scan or MRI might be utilized for further detailed imaging.
Treatment Options
The treatment approach for a pediatric distal radius fracture depends on several factors, including the type and severity of the fracture, the child’s age, and their remaining growth potential. Most pediatric distal radius fractures can be managed without surgery through a process called closed reduction and casting. Closed reduction involves manually realigning the broken bone fragments without making an incision, often performed under local anesthesia or sedation.
Once the bone is realigned, a cast or splint is applied to immobilize the wrist and allow the bone to heal in the correct position. Casts can be made from materials like plaster of Paris or fiberglass, and initially, a splint or bivalved (split) cast may be used to accommodate swelling. For stable buckle fractures, a removable wrist brace or splint may be sufficient, often eliminating the need for a full cast or follow-up.
Surgical intervention is less common but may be necessary for significantly displaced or angulated fractures, open fractures where the bone breaks through the skin, or certain complex growth plate injuries. Common surgical methods include percutaneous pinning, where small wires (Kirschner wires) are inserted through the skin to hold bone fragments in place, often in conjunction with casting. These pins are typically removed in a few weeks once healing is evident.
Recovery and Long-Term Outlook
Recovery from a pediatric distal radius fracture typically involves immobilization, usually with a cast or splint. Most children wear a cast for approximately 3 to 6 weeks, with the exact duration depending on the child’s age and the specific fracture type. Pain usually lessens significantly within the first week.
Follow-up appointments are important, especially if the growth plate was involved, to monitor the bone’s development and ensure proper healing. X-rays may be taken periodically to check for alignment as the bone heals. Children generally recover full strength and motion within one to two weeks after cast removal, often without formal physical therapy.
Children’s bones possess a remarkable ability to heal and remodel, straightening out over time, particularly in younger children. While most children achieve a complete functional recovery, long-term considerations are rare. These might include minor stiffness or, in instances of growth plate involvement, a very rare risk of premature growth plate closure, which can affect bone length. With appropriate care and monitoring, the prognosis for pediatric distal radius fractures is excellent.