Both-Bone Forearm Fracture (Mid-Shaft)

Description

This is a break of both forearm bones in their middle (shaft) portion. It usually takes a harder fall or a direct blow, and it asks for more care than a break near the wrist.

How it happens (the mechanism)

The forearm works as a linked pair: the radius bows around the ulna so the hand can rotate palm-up and palm-down. A higher-energy fall or direct blow breaks both shafts and disturbs that bowed relationship. Unlike the ends of the bone, the shaft does not remodel angles away readily — so the alignment that the bones heal in is close to the alignment they keep.

Why alignment matters

Because forearm rotation depends on the two bones keeping their proper shape and spacing, these breaks are held to a higher alignment standard than wrist fractures. Getting and keeping good alignment is what preserves a full, smooth turn of the palm up and down.

Symptoms

Pain, swelling, and often an obvious bend or deformity of the mid-forearm, with the child unwilling to move the arm.

Doctor examination and imaging

The doctor checks alignment and, importantly, the hand’s feeling and circulation. X-rays of the whole forearm, including the elbow and wrist, show the fractures and rule out an associated joint injury.

Nonsurgical treatment

Many are set back into place and held in a long-arm cast for around six weeks, with X-rays along the way to confirm the alignment holds.

Surgical treatment

If the break is unstable or cannot be held straight, surgery with flexible rods placed inside the bones (or occasionally a plate) gives a reliable result. The choice depends on the alignment and the child’s age.

Recovery and long-term outlook

These heal well. A small number can re-break in the months after healing, so return to contact sports is eased in gradually.

When to call the doctor

Call right away or seek emergency care if pain becomes severe or out of proportion — especially pain when the fingers are gently straightened — or the fingers become numb, pale, blue, or cold, or the cast feels dangerously tight. These can signal dangerous pressure within the arm (compartment syndrome). Also call for fever, worsening swelling, or drainage.

Learn more

OrthoInfo (AAOS) — Forearm Fractures in Children: orthoinfo.aaos.org

This information is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. For specific concerns about your child, consult a board-certified, fellowship-trained pediatric orthopaedic surgeon.