Broken Wrist – Fractures of the wrist and distal radius:
Distal radius fractures occur at the end of the bone near the wrist joint. These are among the most common fractures that we see in children. These fractures typically occur after a fall on the outstretched arm. If you watch the kinds of activities that your child does every day, it is remarkable that broken wrists aren’t more common! Distal radius fractures come in several varieties, ranging from mild to severe.
Torus or buckle fractures
Torus fractures are common. When the child falls on the outstretched hand, the bone buckles under the weight of the body. Typically, you will see a slight bend in the bone, but only on one side. It literally looks like the bone buckled, but didn’t break all the way through. Torus fractures hurt, but will not cause a visible deformity. If you push directly on the arm where it is broken, it will hurt, and the child can localize the spot very clearly. However, they can usually move the wrist joint without much trouble. Because of this, many of these fractures are diagnosed late because it can be difficult for parents to tell if it is broken or not.
Torus fractures need protection from further injury and for relief of pain. Although a splint may be sufficient, most kids are so active that the safest treatment is to place them in a non-removable cast below the elbow for about 3-4 weeks.
Displaced Distal Radius fractures
Some falls are severe enough to completely fracture the end of the radius, producing both displacement (the bones don’t line up end to end) and angulation (the arm is crooked). In this case the arm will look visibly deformed; deciding whether or not your child has a fractures is usually not difficult. Often termed “Colles Fractures”, they are said to have a ‘dinner fork’ deformity to the arm.
Displaced fractures of the distal radius are usually treated with manipulation of the arm to attempt to restore normal alignment to the bones. Because the fractures occur very close to the growth plate, they have an excellent capacity to remodel with time. If there is any residual angular deformity after the fracture has healed, it will remodel as long as it is in the place of motion of the wrist joint.
Growth plate fractures at the wrist
The distal end of the radius is a common site for children to sustain a fracture that actually involves the growth plate itself. These can occur in several varieties. However, it is a very forgiving growth plate to injure. The incidence of have residual problems with growth is usually less than 5 percent with the exception of very severe injuries.
The principles of treatment for any fracture involving the growth plate are to restore anatomic alignment of the growth plate with the minimum amount of trauma. Most displaced growth plate fractures in the distal radius can be manipulated back into normal alignment and held there with a cast. The growth plate will heal very quickly, so prolonged casting is not necessary. Very few fractures of the distal radius will require surgery. Severe growth plate injuries should be followed with x-rays to confirm that normal growth has returned.