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Fractures

What is a fracture?

A fracture is a broken bone; a very common reason for a child’s visit to the ED and one of the most common reasons for referral to a pediatric orthopedist.

Are there any differences between adult and children's bones?

There are several important differences between the bones of children and adults:

1. Children's bones have growth plates that are located at the ends of the long bones and are responsible for the growth of a bone.

2. Because children’s bones are growing, fractures in children’s bones will correct their own shape ("remodel").  Remodeling means that a growing bone which is broken will attempt to fix itself out over time. The closer the fracture is to a growth plate, the more it can remodel.

3. Children's bones have a thicker covering than adults that allows for fast fracture healing and give a fracture some stability. 

4. The child's bone is more flexible; meaning it can bend a lot before it breaks. Overall though the strength of a child’s bone is less than adults so that fractures are more common in children.

5. In children, the ligaments attaching one bone to another are stronger than the bones so that sprains and dislocations are not as common as fractures – the opposite is true with adults.

Do these differences lead to different types of fractures in children compared to adults?

Yes, the types of fractures and the treatment for these fractures are different in children:

·          Growth plate fracture: A fracture in or around the growth plate can have long-term effects. If this part of the bone does not heal properly after the fracture, the bone may grow at an angle or more slowly than the other bones in the body.

·     A fracture in the growth plate is usually not seen on an x-ray because it is made out of cartilage and not bone.

·     A fracture in the growth plate is presumed if there is tenderness over the growth plate on examination despite a normal x-ray. 

·          Since a child's bones can bend a lot before breaking,

       different fracture patterns can be seen in children.

·    A buckle fracture occurs when the bone buckles on one

   side, but it is not separated.

·    A greenstick fracture refers to a fracture where one

   side of the bone breaks from a force while the other side bends but stays intact like bending a fresh tree branch.

How can you tell if a child has a fracture?

·         Usually if your child has a fracture he/she will clearly be in

      pain and unable, or unwilling, to move the injured limb.

·         Swelling and tenderness is typically present around the

      fractured bone.

What is the treatment for a fracture in a child?

• Many fractures seen in the pediatric ER can be safely placed in a splint without an orthopedist seeing your child

• The splint will allow for swelling, which may occur, in the first few days following the injury. 

• Typically, you will be asked to follow up with a pediatric orthopedist within a week of the splint placement for evaluation and possible cast placement when the swelling is decreased.

How can I recognize that there may be a problem with the splint or cast?

You can recognize if a splint or a cast is too tight by looking for the following findings in your child:

1. increase in pain
2. numbness in their fingers or toes
3. change of color of their fingers or toes
   
    

When should I call my pediatrician concerning a possible fracture in my child?

•  It is best to call for specific instructions when you first suspect that your child has a fracture.

·     You should also call your doctor anytime if your child’s

    symptoms worsen such as increased pain or numbness

    or change of color of the fingers or toes.