Fractures of the Wrist (Distal Radius / Ulna)

Children typically sustain two types of injury in the forearm bones near the wrist:

1. Metaphyseal Fractures 

The first is a metaphyseal fracture of the distal radius and/or ulna.  This a fracture that occurs above (proximal) the growth plates and may affect both bones. These fractures do not involve the growth centers in the bones.  

Sometimes these fractures are undisplaced and require a well molded cast to maintain a good position for healing. These fractures do have the tendency to be unstable and thus are monitored regularly early in the healing process to ensure position is maintained.

 

Displaced fractures like the one in this example above require repositioning (a reduction) and a cast to maintain position.  Sometimes it can be difficult to obtain and maintain the fractures in a good position for healing and it may be necessary to place a pin into the bone for a few weeks to give extra stability.

2. Salter Harris Fractures (Fractures Involving the Growth Plate)

The second common type of fracture around the wrist is a fracture of the distal radius and/or ulna that involves the growth plate(s).  The most common version of this is a fracture that splits through the growth plate and then exits proximal to it (up the bone).

 

As this fracture involves the growth center, there is a potential risk of early asymmetric growth arrest in the wrist bones. These fractures are treated similarly to metaphyseal fractures - with cast and possible pinning.

 

Same patient 24 months later. Growth plate has closed but no deformity has occurred.

 For these injures through the growth plate, we monitor patients well after the fracture has healed to ensure that no growth disturbance has occurred at the wrist.

Helpful Links:

What is a growth plate injury?