The purpose of this page is to show you what is involved in treating a distal radius fracture in a child. Ella was nice enough to give me permission to show you what happpened to her broken arm.
Ella is 13 and a great soccer player. She usually plays midfield but this day she was playing the position of a forward. An opposing player kicked the ball VERY hard and it hit her in the right arm. It hurt a lot, a mom on the sidelines (who works in an emergency room! how lucky!) fashioned a splint out of cardboard and Ella's parents (who were cheering her on at the soccer game) brought her to the emergency room. Xrays showed a broken radius and ulna, she was placed into a splint, and she was referred to my office.
The fracture still was hurting a lot:
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This is the xray looking at the arm from the palm side. The big bone on the left is the radius, the little bone on the right is the ulna. The fractures are shown by the red marks. |
This is the xray looking at the arm from the side. The radius and the ulna are seen one on top of the other. The fracture is shown by the red marks and is quite displaced and tilted. |
I got right to work, numbed up the fracture site with some special numbing shots (injection of buffered Lidocaine and Marcaine; I am the only hand surgeon in the US who is a member of the International Association for the Study of Pain, and have been doing pain researchy for 18 years; see my page on Post-Operative Pain) that Ella barely could feel (she told me that, honestly, they did not hurt). I pushed on the bones (the doctors call this a "closed reduction") and put them in a better place. I put a cast on her arm, shaping it to help hold the bones were they belonged. Ella felt much better within five minutes! Look at that championship smile!
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Fractures that are back in place and in a cast usually have little pain, which should be able to be controlled with just Tylenol and Motrin (read the bottle for how much, depending on age). The cast Ella has is called a "short arm cast", in which the elbow is free (so you can scratch your nose!) and the fingers are free (so you can do your homework!). Sometimes, if both bones are badly broken, a cast above the elbow is needed. This is called a "long arm cast". Your arm is not long, the cast is, but that is what doctors call it anyway.
This is what the xray looked like:
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The radius is not much changed on this view, but the alignment is fine. The body will heal and remodel the fracture. |
The radius is much improved here: it is not moved over to the right as much and it is straighter. |
The body will both heal the fracture and will smooth out the shape so that it will look almost normal within a year. Ella wore the case for a total of six weeks (it was changed once), and this is what her fracture looked like:
(to be continued...)
The bones do not need to be completely straight and matched up. While it may be nice, it is not always possible to do this without surgery. The bones have a great ability to remodel (this means heal up and straighten themselves), so surgery in children is not often needed. Read this essay to learn more about the remodelling of bone.
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Would you like to search the medical library of
the National Library Medicine for scientific papers on this topic?
Just click on
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Remember the admonition from the Patient Education Links Page: the Internet has a lot of information, much of it incorrect. I have reviewed the sites that I have linked to, and have only linked to sites when I personally know the surgeon who posted it, or am a member of the organization that posted it. However, I may not agree with all that is on that site, and it may have changed since I reviewed it. If any of the information is not consistent with what I have told you, please download the material and bring it in.
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