Fractures

Pediatric fractures

What is a fracture?

A fracture is a partial or complete break in the bone. When a fracture occurs, it is classified as either open or closed:

• Open fracture (compound fracture): occurs when the broken bone breaks through the skin in the leg.

• Closed fracture (simple fracture): the bone is broken but the skin is still intact.

What are the different types of fractures called?

• Greenstick fracture: A portion of the bone is broken, causing the other side to bend (this resembles what would happen if you tried to break a branch from a tree: it cracks on one side but stays partially intact on the other side).

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• Buckle or torus fracture: One side of the bone bends (buckles) upon itself without breaking the other side

• Comminuted fracture: A bone has broken into more than two pieces. Comminuted fractures often require surgery.

• Growth plate fractures: Children have open growth plates (areas from which bone grows) at each end of their long bones. Injuries to these growth plates are common and in rare cases can result in limb length discrepancies or angular deformities Growth plate fractures are unique to pediatric patients.

• Stress (hairline) fracture: Tiny cracks in the bone, usually caused by overuse or repetitive stress-bearing motions. These are common in children who take dance or run track.

• Non-displaced: the bone cracks or breaks but stays in place.

• Displaced fracture: ends of the broken bone come out of alignment. In a displaced fracture, surgery is usually needed to realign bones.

How are fractures in children different from fractures in adults?

A child's bone differs from adult bone in a variety of ways:

• Flexible bones: A child's growing bones are bendable and resilient, which means they tend to buckle or bend a lot before breaking. This is the reason for the unique fracture patterns seen in children and not in adults. “Greenstick” and “buckle” fractures are two examples.

• Faster healing: Children’s bones are also surrounded by a thick layer of connective tissue (periosteum) that defends the bone against injury and harm. This tissue also produces blood supply to the area of a fracture. The body uses this supply of blood to replace damaged cells. Periosteum in adults tends to be much thinner, resulting in a slower healing process.

• Vulnerable growth plates: Children have open growth plates (areas from which bone grows) at each end of their long bones. Injuries to these growth plates are common and in rare cases can result in limb length discrepancies or angular deformities. In performing surgery on broken limbs in children, surgeons must consider and account for these growth plates.

Risk factors

What factors increase a child's risk of getting a fracture?

Certain factors may increase the risk  for pediatric fractures 

• As children and adolescents approach adulthood, their risk for fractures increases.
• Boys are more likely than girls to get a fracture
• Poor nutrition, including lack of calcium in the diet
• Obesity
• Previous history of fracture(s)

Causes

What causes a child to get a fracture?

Fractures happen when there’s more force applied to the bone than the bone can absorb. These breaks in bones can occur from falls, trauma or a direct blow.

Most childhood fractures result from mild to moderate (rather than severe) trauma that happens while they’re playing and participating in sports, with the rate of fractures peaking in adolescence. The arms are the most common location for fractures.

Signs and symptoms

What are the signs and symptoms of a fracture in children?

• Pain or swelling in the injured area
• Obvious deformity in the injured area
• Difficulty using or moving the injured area in a normal manner
• Warmth, bruising or redness in the injured area

When to see a doctor

Seek medical care immediately if your child displays any of symptoms of a fracture. Do not move your child and call 911 immediately if the bone exits or is exposed through the skin (an open fracture).

For other types of fractures, follow these steps while you are waiting for medical attention:

• Remove clothing from around the fracture without moving the injured limb. You may need to cut clothing off with scissors.

• Apply a cold compress or ice pack wrapped in cloth. Do not apply it directly on the skin. Do not apply heat in any form for at least 24 hours, since heat increases swelling and pain.

• Stabilize the injury as soon as soon as it happens by keeping the injured limb in the position you find it