Surgery for a Forearm Fracture (Plates & Screws or Flexible Nails)

What this surgery is

The forearm has two bones — the radius and the ulna. When one or both are broken and out of place, surgery may be needed to line them up and hold them. Two common methods are used in children:

• Flexible (elastic) nails: thin, bendable metal rods slid inside the hollow center of the bone through small incisions. These are common in school-aged children and are usually removed in a later, smaller surgery once the bone has healed (often 6–12 months later).
• Plate and screws (ORIF): a metal plate is placed on the bone and held with screws through an incision. Plates are often left in place permanently and only removed if they cause a problem.

After surgery the arm is protected in a cast or splint, often a long-arm cast at first.

Why it was done

Forearm bones that are too bent, rotated, or out of place will not heal in a position that allows the wrist and elbow to turn normally. Surgery restores alignment so your child can rotate the forearm (palm up and palm down) again.

Caring for the cast and incision

• Keep the cast clean and dry; keep the arm elevated above the heart for the first 2–3 days.
• Keep any incision clean and covered as instructed. Do not put creams or lotions on it.
• Wiggle the fingers often to reduce swelling and stiffness.
• Do not let your child bear weight on the arm or use it for sports until cleared.

Pain control

• Acetaminophen and ibuprofen, used as directed, control most discomfort.
• Give any prescribed medicine exactly as directed; elevation also helps.

Call our office right away if you notice

• Fingers/toes that are cold, pale, gray, or blue, or that your child cannot move or wiggle
• Numbness, tingling, or burning that does not get better after raising the limb
• Pain that keeps getting worse and is not controlled by the prescribed medicine and elevation
• Fever of 100.4°F (38°C) or higher, or shaking chills
• Swelling that does not go down with rest and elevation
• Redness, spreading warmth, swelling, or pus-like or foul-smelling drainage from the incision
• The cast becomes wet, cracked, soft, too loose, or too tight
• Something gets stuck inside the cast

Call 911 right away if your child has

• Trouble breathing or shortness of breath
• Chest pain
• A pale, gray, or bluish color to the lips or face that does not improve

Follow-up

Most forearm fractures heal in about 6–12 weeks. Your surgeon will check healing with X-rays and tell you when the cast comes off and when sports are allowed. If flexible nails were used, a small surgery to remove them is usually planned 6–12 months later once the bone is solid.

Learn more

For pictures and a family-friendly overview, see the OrthoKids resource linked on this page (OrthoKids: Internal fixation / Intramedullary nail). It is provided by pediatric orthopaedic surgeons.