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DESCRIPTIONAn arm fracture is a complete or incomplete break in one or both bones of the forearm (the radius and the ulna). Appropriate health care includes doctor's treatment; hospitalization (sometimes) to set the fracture or to insert a metal plate that immobilizes broken bones.
SIGNS & SYMPTOMS
Severe arm pain at the time of injury; swelling of the soft tissue around the fracture; visible deformity if the fracture is complete and the bone fragments separate enough to distort the child's normal arm contours; tenderness to the touch; numbness and coldness in the child's lower arm and hand if the blood supply is impaired.
CAUSES
Direct blow or indirect stress to the child's bone. Indirect stress may be caused by twisting or violent muscle contraction.
RISK FACTORS
Contact sports, especially football, soccer, or hockey; history of bone or joint disease, especially osteoporosis; poor nutrition, especially calcium deficiency.
PREVENTING COMPLICATIONS OR RECURRENCEYour child should build strength and protective muscle mass with an appropriate conditioning program. After an arm injury, the child should use padded arm splints for contact sports.
BASIC INFORMATION
MEDICAL TESTSYour own observation of symptoms; medical history and physical exam by a doctor; X-rays of injured areas, including the elbow above and the wrist below the primary injury site. In young people, X-rays of the normal side should be made for comparison.
POSSIBLE COMPLICATIONS
At the time of injury: shock; pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels, or connective tissues.
After treatment or surgery: delayed union or non-union of the fracture; impaired blood supply to the fracture site; avascular necrosis (death of bone cells) due to interruption of the blood supply; death of muscle cells if the arm swells inside the cast; arrest of a child's normal bone growth; infection in open fractures (skin broken over fracture site), or at the incision if surgical setting was necessary; shortening of the injured bones; proneness to repeated injury; unstable or arthritic wrist or elbow following repeated injury; prolonged healing time if the child resumes activity too soon; problems caused by casts.
PROBABLE OUTCOME
The average healing time for this fracture is 6 to 8 weeks in adolescents and adults and 5 to 6 weeks in children. Healing is complete when there is no motion at the fracture site and when X-rays show complete bone union.
TREATMENT
FIRST AID
Keep the child warm with blankets to decrease the possibility of shock.
Cut away clothing, if possible, but don't move the injured arm to do so.
Follow instructions for R.I.C.E., the first letters of rest, ice, compression, and elevation. See Appendix 39 for details.
The doctor will manipulate and set the child's broken bones with surgery or, if possible, without. Manipulation should be done as soon as possible after injury.
HOME CARE
Immobilization is necessary. A rigid cast of plaster splints is placed around the child's injured arm to immobilize the elbow and wrist.
After the child's cast is removed, use frequent ice massage. See Glossary.
MEDICATION
Your doctor may prescribe:
Narcotic or synthetic narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to inactivity.
Acetaminophen (available without prescription) for mild pain after initial treatment.
ACTIVITY
Your child should actively exercise all muscle groups not immobilized. These muscle contractions hasten healing. The child can resume normal activities gradually after treatment, including reconditioning the injured arm, but should not drive until healing is complete.
DIET & FLUIDS
No restrictions after surgery.
OK TO GO TO SCHOOL?Yes, when condition and sense of well-being will allow.
CALL YOUR DOCTOR IF
Your child has signs or symptoms of a forearm fracture.
Any of the following occur after surgery or other treatment: increased pain, swelling, or drainage in the surgical area; signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever); swelling above or below the cast; blue or gray skin color beyond the cast, particularly under the fingernails; numbness or complete loss of feeling below the fracture site; nausea or vomiting; constipation.
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