Causes / typical injury mechanism: Distal radius fractures account for about 40% of all fractures in pediatric patients. Sports-related trauma is the most common etiology of a distal radius fracture, often secondary to a fall on an outstretched hand (FOOSH). The second most common cause is motor vehicle accidents. Distal radius fractures range in severity and can be classified by the location of the fracture; the most common location is the metaphysis, followed by the physis. The physis, or growth plate, is inherently weaker than other regions of the bone due to ongoing maturation of cells. During puberty, physeal fractures are common due to accelerated bone growth without concurrent acceleration of mineralization.

Although isolated distal radius fractures are more common, concurrent distal ulna fractures can occur and should be evaluated for. See both bone fracture. 

Classic history and presentation: The highest incidence in pediatric patients is during their metaphyseal growth spurt (males 12-14 years, females 10-12 years) in individuals who play sports and fall onto an outstretched hand (FOOSH). Children with nondisplaced fractures may present several days following the initial injury. Children have thick periosteum, which helps both to stabilize these fractures and to prevent severe pain.

Prevalence: Distal radius fractures account for about 40% of all fractures in pediatric patients.

• Age – Estimates show that 1% of children will sustain a distal radius fracture and are at highest risk of this injury while going through puberty. The increased risk during puberty is due to accelerated growth of bones over a short period of time without an associated acceleration of mineralization.
• Sex / gender – There is a 2-3:1 ratio of males to females in injury incidence.

Risk factors:

• High body mass index (BMI)
• Participation in high-intensity sports
• Low bone mineral density

Grade / classification system (if any): Salter-Harris classification can be used for physeal fractures.

• Type I – Fracture passes through the physis.
• Type II – Fracture through the physis and metaphysis.
• Type III – Fracture through the physis and epiphysis.
• Type IV – Fracture through the epiphysis, physis, and metaphysis.
• Type V – Crush or compression injury of the physis.