Paediatric Wrist Fractures

Wrist fractures are among the most common bone injuries in children. The most common cause is a fall onto the outstretched hand. Because children's bones are still growing, they heal much faster than adults and can remodel. However, a significant portion of pediatric wrist fractures involve the growth plate (epiphysis), making expert treatment critical to prevent growth disturbances.

Symptoms

After a fall or trauma, the following may be observed:

• Sudden wrist pain preventing use of the limb
• Significant swelling and tenderness
• In some cases, visible deformity ("dinner fork" appearance)
• Pain worsening with movement, avoidance of hand use
• Sometimes restricted finger movement

Diagnostic Methods

After clinical examination, two-view wrist X-rays are mandatory. Since growth plates in children's bones can resemble fractures in normal appearance, evaluation by an experienced pediatric orthopedic surgeon is important. Comparative imaging of the opposite hand may be needed in some doubtful cases. The Salter-Harris classification is used for evaluating growth plate fractures.

Treatment Approach

Non-Surgical Treatments

The vast majority of pediatric fractures are treated by closed reduction (repositioning) and casting. Under anesthesia, the fracture is reset, then an above- or below-elbow cast is applied. The cast is worn for 3-6 weeks. Because remodeling capacity is high, minor angulation is acceptable.

Surgical Treatment

Surgical treatment is typically needed for: fractures not amenable to closed reduction, significant growth plate separation (Salter-Harris III-IV), displaced fragments extending into the joint, or older children where remodeling will be insufficient. K-wires (Kirschner wires) are the most commonly used method for percutaneous fixation. Plates/screws are rarely needed.

Surgical Process

Surgery is performed under brief general anesthesia and takes about 30-45 minutes. The fracture is repositioned under imaging guidance and stabilized with K-wires inserted through the skin if needed.

Hospital Stay

Typically same-day discharge. Some advanced fractures may require 1 overnight observation.

Recovery Process

• Weeks 1-3: Cast or splint immobilization, swelling control
• Weeks 3-6: Cast removed, follow-up X-rays
• Weeks 6-8: Light exercises, gradual return to play activities
• Months 2-3: Return to sports and full activity

Return to Work

For children, return to school is the relevant timing. Children can attend school during the cast period (writing is assessed based on hand condition). Physical education and sports should be avoided for 6-8 weeks.

Potential Complications

Complications are rare in children because their fracture healing is exceptional. The most important follow-up concern is growth disturbance, rarely seen in growth plate injuries — therefore regular control for 6-12 months is recommended.