Fractures of the arm, forearm, and wrist, and elbow are quite common in children. The majority of fractures occur around the elbow and forearm, while fractures near the shoulder or that involve the humerus bone are less common. Below is a brief description of some of the fractures commonly seen and how they are treated at COA:

• Clavicle Fractures:  The clavicle is also known as the collar bone.  Fractures to this bone are quite common because it is very superficial.  Typically, these fractures occur after a fall off a bicycle or a similar mechanism.  Often times, especially in younger children, these fractures heal in a few weeks with the use of a sling.  In adolescents, if the bones are separated quite far from each other, your physician may recommend surgery to bring the fracture in closer alignment.
  
  
• Shoulder Fractures:  The shoulder is an anatomic structure encompassing four joints.  Typically, if your physician says that your child broke his/her “shoulder”, this is typically referring to the upper portion of the arm (humerus) bone.  These fractures tend to heal quickly due to its blood supply.  In addition, because these fractures occur near or within the growth area, the fractures can heal quite crooked, and yet the body will straighten out the bone with time.  That being said, surgery to repair these fractures is quite rare.  Most often, your child’s arm will need to be immobilized in a sling with a swathe around the body to help keep the arm in a steady position.
  
  
• Arm Fractures:  Fractures of the humerus bone require immobilization for just a few weeks.  It is extremely rare for treatment of these fractures to require surgery because there is a great deal of motion that occurs at the shoulder and the elbow joints. It is very difficult to apply a cast to a humerus fracture because the bone often breaks above the level of where a long cast ends.  Therefore, your physician will often place your child in either a shoulder immobilzer or a splint that rests above the shoulder.  After several weeks, your child may be fitted for a special brace to protect the bone while it completes its healing.  Long-term consequences of humerus fractures are quite rare.
  
  
• Elbow Fractures:  There are several fractures that occur around the elbow.  Most of them occur when a child falls from a height, such as off the monkey bars.  Unfortunately, many fractures that occur near the elbow require surgery to realign the bones.  This is because either the fracture pieces are separated quite far from each other and would heal poorly if left in this position or the fracture crosses into the elbow joint and it is recommended to align the bones as perfect as possible to prevent future arthritis.  Most of the time, your doctor will place 2-3 sterile metal pins across the fracture to hold it in place.  Those pins stay outside the skin but are protected underneath the cast.  Those pins are removed after approximately 3-4 weeks in the office.  Removing the pins in the office is not painful, but some children become very frightened by either the removal of the cast or pulling of the pins.  We recommend that you bring a distraction for your child – headphones with music, a favorite toy or game are often very helpful.  Once the pins are removed, your child will either be placed back in a cast for a few weeks, or more likely, will be allowed to start moving his/her arm.  The majority of the time, there are no long-term consequences of having one of these elbow fractures.  Some children may be a little stiffer on the fractured side versus the non-fractured side, and occasionally, the bone doesn’t heal in the exact position as it was placed during surgery.
  
  
• Forearm Fractures:  These fractures are quite common in children of all ages, and are typically the result of a fall.  Fractures that occur in children less than 10 often fare well without surgery and are treated in a cast for approximately 6 weeks. However, sometimes, the fractures move within the cast into an alignment that may decrease function in the future.  If that is the case, your doctor may recommend a surgery to place a temporary rod in either one or both of the bones in the forearm.  The rods typically stay inside the bone for approximately 6 weeks, and are then removed surgically on an outpatient basis.

For preteens and adolescents, forearm fractures may not be as amenable to cast treatment only.  There are three main reasons for this – 1) these children are older, and do not have as much growth remaining as a small child, and therefore, the bones have to heal straighter in order to ensure proper forearm functioning once the fracture heals, and 2) the properties of the bone differ in that the lining around the bone is not as thick, and the broken bones have an easier time moving around in the cast, and 3) along the same lines – older children have bigger and stronger muscles than younger ones, so these muscles are more likely to cause the fracture pieces to move around in the cast.  For all these reasons, if your child is older, he/she may be more likely to require a surgery to ensure the bones stay properly aligned.  That being said, all attempts are made initially treat the fracture with a cast.

Once the fracture is healed enough to be removed from the cast, sometimes your physician or PA may recommend a fracture brace to wear for a few weeks.  Unfortunately, the fractures that occur in the middle of the forearm have a high chance (approximately 5%) of breaking again within the first 18 months after the initial break.  Therefore, it is important to keep the forearm protected for as long as possible.

• Wrist Fractures: Although we will call these fractures “wrist fractures” – this is actually a misnomer as the bone really breaks at the end of the forearm bones near the wrist joint. The bones are called the radius and the ulna. The radius is on the side of the thumb while the ulna is on the side of the pinky. These bones break in one of three ways:
• Both bones break away from the growth plate
• One or both bones break within the growth plate
• One or both bones “buckle” in a relatively weaker aspect of the bone

If the bone breaks away from the growth plate, many times, the pieces are separated far from each other and may require the pieces to be manipulated under sedation to improve the alignment for healing. Once the pieces are lined up in a reasonable fashion, your child will likely be placed in a cast that goes above the elbow for a month, and then a shorter cast for several more weeks. At first, you may be seeing your physician or PA weekly, until the fracture demonstrates enough healing that it is likely not to move any more in the cast. Once the casting is done, occasionally, your child will be prescribed a wrist brace to wear for several weeks for extra support.

If the bone breaks within the growth area, similar to the above scenario, an initial attempt will be made to assure that the bones line up as straight as possible. Treatment is very similar as what is described above. However, your health care provider may ask you to return approximately six months following the fracture to ensure that the bone is growing normally. For more information, please review the section on growth plate fractures.

In children, sometimes the bone “buckles” rather than breaks. These fractures, luckily, are not as painful as some of the other fractures that occur, and they also heal very quickly with little consequence. Often times, your child will be placed in a cast for 3-4 weeks, and that may be the only treatment necessary.