Hand and upper extremity fractures (broken bones)

Taking a hard spill on the playground, falling off a bike or overusing a muscle while playing sports — kids can break bones when you least expect it. These common injuries can be especially difficult when they affect the shoulder, elbow, forearm, hand or fingers — all parts of the body that kids rely on for everyday tasks.

When and where to get help

Children’s Wisconsin offers same-day care for broken bones at locations across southeast Wisconsin.

• For emergency care: If your child’s broken bone has severe pain, bleeding or the bone is bent the wrong way, go straight to our emergency room. An orthopedic specialist is always on call. If there is severe bleeding or your child is experiencing other symptoms, call 911. Find our emergency room.
• For care before 4 p.m. on weekdays: Call (877) 607-5280 to make an appointment with an orthopedic specialist at one of our clinics in Delafield, Greenfield, Kenosha, Mequon or at our main hospital in Milwaukee.
• For care after 4 p.m. on weeknights and weekends: Visit any of our urgent care locations.

About hand and upper extremity fractures in kids

There are many bones in the hands and upper extremity, and fractures in this part of the body can vary in type and severity. They include:

• Open fracture – in rare cases, the bone goes through the skin
• Closed fracture – the bone breaks but remains inside the skin
• Displaced fracture – the broken ends of a bone no longer match up
• Non-displaced fracture – the bone is cracked but the pieces remain straight and together
• Stress fractures – tiny cracks in the bone, also known as hairline fractures

Because children’s bones are more flexible, they are also susceptible to unusual bone breaks, such as:

• Buckle fracture – one side of the bone is dented or “buckles”
• Greenstick fracture – a crack on one side of the bone causes the other side to bend

Fractures in the hand and upper extremity can include:

• Shoulder – The shoulder bones include the clavicle (collarbone), scapula and proximal humerus.
• Elbow – The elbow joint contains three bones: the humerus, radius and ulna.
• Forearm – Up to half of all childhood fractures occur in the forearm, which contains two bones: the radius and ulna. Forearm fractures often involve the growth plate. 
• Hand – The human hand is incredibly complex, with 27 bones: the carpals at the base of the hand, metacarpals in the mid-hand and phalanges in the fingers. Most hand fractures involve growth plates and need specialized treatment.
• Wrist – The wrist includes the eight small bones in the base of the hand and the two bones of the forearm. 

Experts in hand and upper extremity fractures

As the only comprehensive pediatric hand and upper extremity program in the state, Children’s Wisconsin provides expert care to kids and teens with a wide range of common and rare conditions affecting the shoulder, arm, elbow, wrist and hand. With our team’s specialized training, vast experience and deep knowledge of the unique challenges of children’s growing bodies, we can ensure the best possible outcomes for your child’s recovery after a hand or upper extremity fracture. Our child-centered environment and wraparound services are designed to support the whole family and provide comfort when your child is stressed and in pain. If your child has already been diagnosed at another center, we invite you to get a second opinion at Children’s Wisconsin.

What causes fractures in the hand and upper extremity?

Broken bones usually occur after a fall (particularly when landing hard on an outstretched hand/arm) or during a traumatic blow to the area, such as a car accident. Hand bones can break when a child twists their hand in an awkward way or gets their hand crushed, such as when a young child gets their fingers caught in a door. Stress fractures can occur over time, particularly in young athletes who are doing a lot of repetitive motions that fatigue the muscles.

Why are hand and upper extremity fractures a concern?

These injuries can cause children a significant amount of pain, and without proper and immediate treatment, the injury could get worse or become more difficult to heal. Kids and teens have growth plates at the end of their bones which can also be injured during a fracture. If not properly managed by a pediatric expert, an injured growth plate can lead to long-term problems, including shortening, deformities and arthritis.

What are the symptoms of hand and upper extremity fractures?

Signs of a broken bone could include:

• A snapping noise at the time of injury
• Pain — usually more severe than the usual bump or bruise
• Swelling
• Numbness/weakness in the affected area
• The bone no longer looks straight, is bent the wrong way or is visible through the skin

If you suspect your child might have a fracture, seek medical assistance right away. Even if you think it’s just a sprain, it’s a good idea to see a doctor to have the injury assessed and rule out a broken bone.

How are hand and upper extremity fractures diagnosed?

The physician will evaluate your child’s injury through a physical examination and imaging. At Children’s Wisconsin, we use imaging procedures that ensure your child is exposed to the smallest amount of radiation possible. Imaging procedures may include:

X-rays – Uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film.

Magnetic resonance imaging (MRI) – Uses a combination of large magnets, radio frequencies and a computer to produce detailed images of organs and structures within the body. This test is done to rule out any associated abnormalities of the nerves.

Computed tomography scan (CT scan) – Uses a combination of x-rays and computer technology to produce cross-sectional images (often called “slices”), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat and organs.

Treatment for hand and upper extremity fractures

Treatment will vary depending on the type and severity of your child’s injury. Your child’s treatment may include:

Closed reduction – If the bone is not in the right place, your child’s doctor will numb the area and move the bones back into place, a procedure called a closed reduction. More commonly known as “setting” the bone, this procedure does not involve cutting open the skin.

Surgical repair – In rare cases, your child might need a procedure called an open reduction to treat a severe or complicated fracture. Our highly skilled pediatric orthopedic surgeon will surgically repair the bones, tendons and soft tissue in a precise and delicate manner to preserve your child’s movement and function in the future. The surgeon might use screws, wires or metal plates to hold the bone fragments in place.

Sling/splint/cast – Once your child’s bone is in the right place, they will need to wear a sling, splint or cast (depending on the area injured) to immobilize and protect the area so the bone can heal.

Medical management – Anti-inflammatory medications can relieve a child’s pain immediately after the injury and as they recover.

Hand therapy – Hand therapy is a critical part of the postsurgical and nonsurgical process to promote healing, increase range of motion and maximize functional use of your child’s hand/arm. Our certified hand therapist offers serial casting, custom splinting, paraffin wax treatments, scar massage and more.

Rest – Your child will need to take a break from athletics or other activities that worsen their discomfort until they heal. Recovery time depends on the location and type of fracture.

Long-term outlook for hand and upper extremity fractures

Recovery from fractures in the hand and upper extremity can take time, but with proper treatment, your child should heal and eventually be able to resume normal activities. A fracture involving the growth plate might require further monitoring or surgical repair if your child develops complications that affect the length or shape of their bone.