Paediatric Fracture Trauma
Fractures in Children
A fracture is a partial or complete break in the bone. When a fracture happens, it is either open or closed.
- Open (compound) fracture. The bone breaks through the skin. Or the skin has a deep wound that exposes the bone.
- Closed (simple) fracture. The bone is broken, but there is no wound in the skin.
Fractures happen when more force is applied to the bone than the bone can absorb. Bones are weakest when they are twisted. Breaks in bones can happen from overuse injuries, falls, trauma, or a direct hit to the body.
Symptoms can occur a bit differently in each child. Below are the most common symptoms if your child breaks a bone:
- Obvious deformity of the bone
- Trouble using or moving the bone in a normal way
- Warmth, bruising, or redness
These symptoms may seem like other health problems. Make sure your child sees their healthcare provider for a diagnosis.
Your child’s healthcare provider makes the diagnosis with an exam and diagnostic tests. During the exam, you will be asked about your child’s health history and how the injury happened.
Your child may also need:
- X-rays. This test makes images of internal tissues, bones, and organs.
- MRI. This test uses a combination of large magnets, radio waves, and a computer to make detailed images of organs and structures within the body.
- CT scan. This test uses X-rays and a computer to make detailed images of the body. A CT scan shows details of the bones, muscles, fat, and organs. The test is more detailed than general X-rays.
Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is.
An open fracture is an emergency. This is when the bone breaks through the skin. Or when the skin has a deep wound that exposes the bone. Call 911 or your local emergency number to get medical help right away.
The goal of treatment is to control the pain, help the bone heal, and prevent complications so your child can use the fractured area again normally. Treatment may include:
- Splint or cast. This keeps the broken bone in place while it heals.
- Medicine. Certain medicines can help ease the pain.
- Traction. This treatment gently stretches the muscles and tendons around the broken bone to allow the bone ends to align and heal. It uses pulleys, strings, weights, and a metal frame attached over or to the bed.
- Surgery. Your child may need surgery to put certain types of broken bones back into place. Sometimes the surgeon puts metal rods or pins inside the bone or outside the body to hold the bone pieces in place. This helps them heal in the correct position.
Key points about a fracture in a child
Common Childhood Fractures
What are the symptoms of a fracture?
The signs and symptoms of a fracture include:
What are the risks for fractures?
Fractures are commonly associated with sporting accidents, falls from heights, and bike and car accidents. Poor nutrition, a diet low in calcium, and obesity can all increase a child’s fracture risk.
How are a child’s bones different from adult bones?
Children’s bones grow throughout childhood. This growth potential allows children’s bones to “remodel,” or naturally correct some or all of the deformity caused by a fracture. Because children’s bones are growing, they also break in different patterns compared to adult bones.
Children’s bones are more flexible.
Growing bones tend to buckle or bend before breaking, which often leads to unique fracture patterns. For instance, one side of a bone may bend, causing a greenstick (bending) fracture. Or one side of the bone can buckle and become dented, causing a buckle fracture.
Children have vulnerable growth plates
Children have soft areas of cartilage at the ends of their bones, called growth plates, where growth takes place. These areas of growth are often at risk when a child suffers a fracture. Growth plates can be injured at any stage of development, but are more common in early adolescence when growth plates are in their final stage of growth.
Children’s bones heal faster
A thick layer of connective tissue (known as periosteum) surrounds a child’s bones and defends the bone against injury and fracture. This tissue provides blood supply to the bone. If the bone breaks, the body uses this supply of blood to replace damaged cells and heal the bone. As children grow into adulthood, their periosteum tends to thin out and provide less support. This is why adults’ bones heal more slowly than children’s bones.
What are the different types of fractures?
Bones fracture in a variety of different ways. Most fractures result from mild to moderate trauma, such as a fall or a direct blow while a child is playing or participating in sports. If there’s more force applied to the bone than the bone can absorb, it will break or buckle. The amount and type of force will affect the type of fracture.
With non-displaced fractures, the bone typically stays aligned in an acceptable position for healing. Such fractures are usually treated with a splint, brace, or cast. This immobilizes the injured bone, promotes healing, and reduces pain and swelling.
Single non-displaced fractures: The bone cracks or breaks but stays in place.
Stress fractures (hairline fractures):
Tiny cracks form in the bone, usually as a result of overuse or repetitive stress-bearing motions. Stress fractures are common in children who run track or participate in gymnastics or dance.
Torus or buckle fractures: One side of the bone bends (buckles) upon itself. The bone is dented but not broken. This is a common childhood injury that typically results from a simple fall.
When a fracture is displaced, the ends of the bone have come out of alignment. In such cases, the broken bone needs to be set back into alignment so it will heal properly. This is called a reduction. After the reduction, the injured limb is immobilized with a brace, splint, or cast while the bone heals. If the reduction is unsuccessful, other treatments may be necessary.
Types of displaced fractures include:
Angulated fractures: The two ends of the broken bone are at an angle to each other
Translated fractures: The ends of the bone have shifted out of alignment
Rotated fractures: The bone spun (rotated) when it broke.
Greenstick fractures: One side of the bone is broken, causing the other side to bend. A greenstick fracture resembles a broken tree branch. The branch cracks on one side but remains partially intact on the other.
Other severe fractures: Some fractures require reduction or surgery, or the bone will not heal properly. Examples include:
Comminuted fracture: The bone has broken into more than two pieces that no longer line up properly.
Compression fracture: The bone collapses under pressure. This is most serious when it involves a joint surface.
Growth plate fractures: Growth plate fractures are typically caused by great force during sports or playground accidents. Depending on the seriousness of the fracture, they may be treated with a splint, cast, or walking boot. Some serious growth plate fractures require surgery.
In rare cases, growth plate fractures can slow the growth of the affected leg or arm. Damage to a growth plate can also cause the limb to grow at the wrong angle. When surgeons operate on broken limbs in children, they must protect the growth plates as much as possible.
Open and closed fractures:
Bone fractures are classified as either open or closed. A closed fracture occurs when the bone is broken, but the skin remains intact. An open fracture, also known as a compound fracture, occurs when the broken bone breaks through the skin. Open fractures are rare. They can become infected if not treated appropriately and require immediate surgical attention.
How we care for fractures
Every year the Orthopedics and Sports Medicine Center at Boston Children’s Hospital treats thousands of children, adolescents, and young adults with fractures of all complexities. Thanks to our pediatric expertise, we can precisely diagnose conditions related to the growing musculoskeletal system and optimal care plans. At our Orthopedic Urgent Care Clinics, we care for injuries that require prompt medical attention but are not serious enough to need emergency room care.
Our experts in orthopedic care have created a series of helpful guides that cover different types of fractures, clinical treatment, home care, and expected recovery times.
- Shoulder, upper arm
- Clavicle fracture
- Supracondylar humerus fracture
- Humeral shaft fracture
- Proximal humeral fracture
- Occult elbow injury
- Olecranon fracture
- Medial epicondyle fracture
- Lateral condyle fracture
- Bicoritical distal radial fracture
- Distal radius buckle fracture
- Proximal radius fracture
- Distal radius growth plate fracture
- Both-bone forearm fracture
- Radial shaft fracture and greenstick fracture
- Hand, wrist
- Metacarpal fracture
- Scaphoid fracture and occult scaphoid injury
- Lower leg
- Tibia fracture, toddler fracture, and Cozen’s fracture
- Tibial shaft fracture and tibia-fibula fracture
- Tibial tubercle fracture
- Ankle, foot
- Ankle fracture
- Metatarsal fracture
What are the treatments for a fractured bone?
Treatment will be based on the type of fracture, its severity, and your child's age. In most cases, fractures in children are treated with a sling, splint/brace, cast, or walking boot. These immobilize the injured bone while it heals.
Doctors often put a splint on a newly broken bone if they are concerned about swelling. If the injured area swells, a cast could become too tight and reduce blood circulation. Typically, the splint will be replaced with a cast once swelling has gone down. Splints are also used for minor fractures that don’t require a cast.
A broken ankle, foot, or leg may be stabilized with a boot. The Aircast boot immobilizes the foot and ankle but can be removed for bathing or icing under certain circumstances.
Depending on the severity of the break and stage of healing, it may be OK to remove the boot for short periods for icing or bathing.
Casts are stronger than splints and provide more protection to the injured area. Casts have two layers: a soft inside layer that rests against the skin and a hard, outer layer that protects the injured bone and prevents movement while the bone heals. The type of cast used will depend on the type of fracture.
A reduction is a non-surgical procedure to set the bone so it will heal properly. The doctor
realigns the broken bone from outside the body and puts the injured limb in a cast or splint.
Reductions are usually performed in an emergency department with medications that manage pain and make your child sleepy or sedated so they won’t remember the procedure.
Severe or unstable fractures that can’t be set properly with a reduction require surgery. To increase the chances that the bone will heal in the correct position, your child’s doctor will decide very early in treatment whether to operate. In some cases, however, if the area around the fracture is swollen, the procedure may have to wait until the swelling goes down.
The child will be sedated or under general anaesthesia in the operating room and the doctor will set the bone into place. A pin may be used to hold the pieces of bone securely in place while the bone heals. If the fracture involves a joint, the surgeon will realign the joint and hold it in place with screws, a plate, or a pin.
Traction uses a gentle, steady pulling motion in a specific direction to allow the ends of the broken bone to align and heal. In some cases, traction reduces painful muscle spasms.
Medication is sometimes used to help control pain and muscle spasms. If a fracture is open, antibiotics are used to prevent infection.
Fractures in children or Paediatric trauma or fracture is treated here at shreeji orthopaedic hospital in gurukul road, ahmedabad india, 24 hours a day in emergency. Dr Hardik Sha is a Trauma surgeon and expert in treating general fractures in all age groups including children also.