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Broken Arm

  • Overview

    Broken arms in children

    Read the information in the following pages to learn more about diagnosis and treatment that Boston Children's Hospital provides for every type and severity of broken arm in children. 

    What are broken arms?

    A broken arm occurs when there is a crack or break in one (or more) of the three bones in the arm: the humerus, radius or ulna. Broken arms are often caused by an impact injury, such as from a fall (as when a child uses his outstretched arm to break a fall), or a direct blow.

    A simple break in the arm is usually treated with a splint or cast, while more complex breaks may require surgery. With proper treatment, broken arms can heal completely. Full use of the arm is often regained within a couple weeks after the final cast is removed.

     

    Broken arm: Reviewed by Travis H. Matheney, MD, MLA
    © Boston Children’s Hospital, 2012

     

    Boston Children's Hospital
    300 Longwood Avenue
    Fegan 2
    Boston MA 02115

    617-355-6021 

  • In-Depth

    What are the different bones of the arm?

    The arm is made up of two parts. The upper arm refers to the part of the limb between the shoulder and elbow. The lower arm (forearm) refers to the part of the limb between the elbow and the wrist.

    Ulna

    • The ulna runs from the tip of the elbow to the little finger side of the wrist.

    Radius

    • The radius is bigger and longer than the ulna and runs from the elbow to the wrist.

    Humerus

    • The humerus is the long bone in the upper arm. One end connects at the shoulder and the other end connects with the radius and ulna at the elbow joint.

    Learn more about the different types of fractures in children

    Causes

    What causes broken arms in children?

    A bone breaks when there’s more force applied to the bone than it can withstand.

    Childhood broken arms can be caused by:

    • Falls: Falling onto an outstretched hand is the most common cause of a broken arm.
    • Trauma: Direct trauma to the arm (for example, as a result of a car or bike accident) can cause any of a child’s arm bones to break.
    • Sports injuries: Many broken arms occur as a result of mild to moderate (rather than severe) trauma that happens while children are playing or participating in sports.

    Certain risk factors may also increase a child’s chances of breaking an arm

    Signs and symptoms

    What are the signs and symptoms of broken arms in children?

    Common signs of a broken arm include:

    • Pain or swelling
    • A noticeable abnormality, such as bent arm or wrist
    • Difficulty using or moving the arm normally
    • Warmth, bruising or redness
  • Tests

    How are broken arms in children diagnosed?

    To diagnose broken arms in children, the doctor will carefully examine the injured area for tenderness, redness and swelling.

    One or more of the following imaging techniques may also be used to get pictures of the broken bone and to check for damage to muscles or blood vessels:

    X-ray

    An x-ray of the arm is the main tool used for diagnosing a broken bone. This painless test uses small amounts of radiation to produce images of bones onto film.

    After the doctor puts the pieces of the broken bone in the right position, an x-ray can also help determine whether the bones in the arm are healing in the proper position.

    Other diagnostic tools include:

    • Magnetic resonance imaging (MRI): Some fractures (such as stress fractures), don't show up on an x-ray until a few weeks after the bone starts hurting. An MRI is a diagnostic procedure that uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body. These types of tests are more sensitive than x-rays and can pick up smaller fractures before they get worse.
    • Computed tomography scan (CT, CAT scan): a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body.
    • Bone scan: a painless imaging method that uses a radioactive substance to evaluate bones and determine the cause of pain or inflammation. Bone scans are also useful for detecting stress fractures and toddler’s fractures, which can be hard to see on x-rays
  • How are broken arms in children treated?

    Treatment of broken arms depends on the specific location and degree (severity) of the break and your child's age, overall health, and medical history.

    Your physician will determine your child's treatment plan and follow-up based on her physical examination and other tests.

    Non-surgical treatments

    Casts and splints

    Splints and casts immobilize the injured bone(s) to promote healing and reduce pain and swelling. They are sometimes put on after surgical procedures to ensure that the bone is protected and in the proper alignment as it begins to heal.

    • Splints are used for minor breaks. Splints support the broken bone on one side and immobilize the injured area to promote bone alignment and healing. Splints are often used in emergency situations to hold a joint in a steady position during transportation to a medical facility.
    • Casts are stronger than splints and provide more protection to the injured area. They hold a broken bone in place while it heals by immobilizing the area above and below the joint. For example, a child with a forearm fracture will have a long arm cast to immobilize the wrist and elbow joints.

    Some common types of casting  for broken arms include:

    Click to enlarge

    TYPE

    LOCATION

    USES

    Short arm cast

    Applied below the elbow to the hand

    Forearm or wrist fractures; also used to hold the forearm or wrist muscles and tendons in place after surgery

    Long arm cast

    Applied from the upper arm to the hand

    Upper arm, elbow or forearm fractures; also used to hold the arm or elbow muscles and tendons in place after surgery

    Arm cylinder cast

    Applied from the upper arm to the wrist

    To hold the elbow muscles and tendons in place after a dislocation or surgery

     

    Traction and closed reduction

    • Traction corrects broken or dislocated bones by using a gentle and steady pulling motion to stretch muscles and tendons in a specific direction around the broken bone. This allows the bone ends to align and heal, and in some cases, it reduces painful muscle spasms.
    • Closed reduction is a nonsurgical procedure used to reduce and set the fracture. Using an anesthetic (typically given through an IV in the arm), the doctor realigns the bone fragments from outside the body and holds it in place with a cast or splint.

     

    Surgical treatment

    Surgery may be needed to put broken bones back into place. A surgeon may insert metal rods or pins located inside the bone (internal fixation) or outside the body (external fixation) to hold bone fragments in place to allow alignment and healing. This is done under general anesthesia.

  • Research & Innovation

    The Hand and Orthopedic Upper Extremity Program, located within the Orthopedic Center at Boston Children's Hospital, provides comprehensive care to infants, children and adolescents with congenital, neuromuscular, sports-related, oncologic and traumatic/ post-traumatic conditions of the upper extremity. 

    Our program is also committed to improving clinical care through continued clinical and basic science research. Along with its leadership in the field of brachial plexus birth palsy, our multidisciplinary team studies the treatment of a wide variety of upper limb conditions, including:

    • surgical correction of forearm deformity following previous fracture
    • ligament and/or cartilage injuries of the wrist
    • post-traumatic stiffness and deformity of the elbow
    • instability of the sternoclavicular and glenohumeral joints of the shoulder
    • the use of microsurgical techniques in reconstructive surgery for congenital upper extremity differences
    • the use of microsurgical techniques in reconstructive surgery following limb salvage for bone and soft-tissue tumors
    • reconstruction of the congenitally deficient hand

    Many of these investigations have resulted in national and international presentations or peer-reviewed medical publications, and all have increased our ability to provide the highest standard of patient care.

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