Broken Wrists In Children

broken-wrist-xray

X-ray of a broken wrist in a child after a splint is put on

Overview

Broken wrists are perhaps the number one fracture in children I see in the office every week (especially in the summer!).

Fortunately most wrist fractures in kids are minor, troublesome injuries that make parents more upset than the patient. But they can sometimes be tricky, so it’s best to be as prepared as possible when you suspect your child has a broken wrist.

This overview article will help summarize wrist fractures and what’s usually done to treat them.

How serious is a broken wrist?

Kids fall and land on their outstretched arms and hands all the time. Many even scream, cry, and generally attract a lot of attention after an injury. Thankfully most kids shake off injuries quickly and go right back to playing.

When they don’t, it’s wise to keep a close eye on them and how they use the hand after an injury.

Wrist fractures can create serious problems, but most heal on their own just fine with very simple treatment.

Here are a few complications from badly treated wrist fractures that can happen when parents and doctors don’t pay attention or treat these injuries lightly:

  • cosmetic deformity – permanently bent wrists
  • permanent stiffness (wrist doesn’t bend, straighten, or twist normally)
  • chronic pain with twisting/bending the wrist
  • bone or joint deformity requiring complex surgery later
  • joint deformity that turns into arthritis later
  • pressure on and damage to nerves and blood vessels
  • growth plate damage causing normal growth to stop

How do children break their wrists?

Most wrist fractures are caused by a fall from high up, like from monkey bars or off a bunk bed. However, some breaks happen just from falling from a standing position or off a bike.

Usually the wrist breaks when it’s bent backwards (the position a waiter uses to hold a large platter above his head as he carries it through a crowded restaurant). The wrist bends back past the point of normal range of motion (like for a pushup or pushing up from an armchair) and the bone cracks or snaps.

Wrist fractures can also occur in sports injuries, gymnastics, car wrecks, trampoline injuries, and general goofing off with parents, siblings, and friends.

Common types of wrist fractures

A wrist is actually the joining of the two forearm bones (radius and ulna) and the eight small wrist bones (called carpal bones).

When doctors talk about wrist fractures, they usually mean a break of the radius and/or ulna bone.

Radius fractures

Most children’s wrist fractures involve the radius bone – it’s the wider of the two forearm bones down by the wrist.

The bone usually doesn’t even break all the way through, especially in kids younger than 12 or so. This is called a buckle fracture, where one wall of the bone “buckles” or “crumples” inward. These are usually very stable fractures and don’t require complicated treatment.

Ulna fractures

The ulna is the smaller of the two forearm bones down by the wrist, and usually is broken along with the radius bone. This is usually a small chip fracture and heals along with the radius fracture.

Combination radius and ulna fractures

Most wrist fractures that need surgery are in this category. It takes a lot of force to break both bones.

Sometimes the radius shaft will break in half, then the carpal bones dislocate away from the ulna bone. This type of fracture is serious and usually only happens in older children. It’s also quite unusual.

Signs of a wrist fracture

It can be challenging to figure out whether your child has a broken or just a sprained wrist. Here are some general guidelines that suggest the wrist is broken:

  • large amount of swelling
  • difficulty moving the wrist
  • pain when trying to move the wrist
  • crunching or popping with bending/straightening, or turning the palm up and down
  • any bruising
  • extreme tenderness/pain when touching the bones around the wrist
  • refusal to use the hand or put weight on it
  • When to take your child to the doctor after a wrist injury

If the thought crosses your mind that your child has a broken wrist, take them in to see the doctor. Either go directly to an orthopedic specialist or see your regular doctor for a recommendation.

Only a careful examination and x-ray can confirm a suspected fracture.

How broken wrists are diagnosed

A specialist (usually an orthopedic surgeon or hand surgeon) can determine if a break is present by examining your child and seeing a few well-done x-rays.

Most wrist fractures are visible on regular x-rays. Occasionally the fracture can’t be seen, but the child’s wrist is so tender to touch that it’s safe to assume there’s a crack we can’t see.

Treating your child’s broken wrist

Casting and splinting

Thankfully, most kids just need a short-arm cast or good well-fitting velcro brace to treat their wrist fracture.

Depending on the child’s age, casts and splints need to be in place for at least 3 to 6 weeks so the bone can heal.

Often the most stressful decision involves mom or dad deciding if they can trust their 7 year old to keep his splint on, so they opt for a cast and deal with the minor hassle of keeping it dry in the tub.

Surgery

If a specialist recommends surgery – don’t panic – just take a deep breath and ask good questions!

Sometimes surgery may simply mean putting your child to sleep and straightening the bone, then putting on a splint or cast in the operating room.

Small pins or wires are sometimes required to stabilize the bone during healing. These are placed through the skin and incisions are rarely necessary.

Results of treatment

The younger the child, the more the body’s healing process will straighten out even the most crooked bone.

Even so, most parents prefer the bone be straightened if possible and safe.

Fractures heal in about 6 weeks in older children and in as little as 3 weeks in very young kids.

Healing time is the same whether surgery is done or not. Once the cast comes off or pins come out, therapy is rarely necessary and most children go back to normal activities after adjusting to a cast-free arm over a period of a couple of days.

Sometimes if a fracture involves growth plates or requires surgery, a surgeon may want to see your child back in a few weeks or a few months to check another x-ray or check for any leftover stiffness.

 

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