KidsMD Health Topics

Fractures

  • Pediatric fractures

    Fractures happen when there’s more force applied to the bone than the bone can withstand. If your child has a fracture, it means that his bone has partially or completely broken.

    A fracture in a child can be very different from a fracture in the same location in an adult, so it requires treatment by doctors and nurses trained to take care of children. Pediatric patients are at risk for a specific set of fractures for a variety of reasons. If the fracture involves the ends of the bone, it can affect the growth of the bone. 

    Orthopedic Center News

    A pair of studies finds mistakes are common in treating pediatric fractures.

    If this is a medical emergency, dial 9-1-1 immediately.

    Orthopedic Center
    Boston Children's Hospital
    300 Longwood Avenue
    Fegan 2
    Boston MA 02115
    617-355-6021

  • 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)
    • 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.

    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)

    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
  • How are fractures in children diagnosed?

    Your child’s doctor will closely examine the injured area for tenderness, redness and swelling and will order diagnostic imaging tests. 

    Diagnostic tests may include:

    • X-ray: X-ray imaging uses invisible electromagnetic energy beams to produce images of internal tissues, bones and organs onto film; it is usually sufficient for diagnosing the majority of fractures.
    • Magnetic resonance imaging (MRI): Some fractures (such as stress fractures) don't show up on an x-ray until a few weeks after the bone starts hurting. An MRI is a diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body. These types of tests are more sensitive than x-rays and can pick up smaller fractures before they get worse.
    • Bone scan: A bone scan is another type of non-invasive imaging technique that uses a radioactive substance to visualize the bones.
    • Computed tomography scan (CT, CAT scan): A CT scan is a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body.
  • Children's bones are softer than adult bones, which enables them to heal more quickly. This is good news for recovery, but it also means that your child should get medical and/or surgical attention quickly to ensure that the bone is kept in the correct position as it heals.

    How are fractures treated?

    Specific treatment for a fracture 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 splint or cast, which immobilize the injured bone(s) to promote healing and reduce pain and swelling.

    Splints

    • Doctors will usually put a splint on a newly broken bone because a cast can be too tight and can affect circulation. They will replace it with a cast once the swelling has gone down. Splints are also used for minor fractures.
    • 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 prevents the injured bone from moving.

    Other treatments for fractures include:

    • Medication to control pain and to prevent infection if the fracture is open
    • Surgery may be needed to put broken bones back into place. The surgeon may also insert metal rods or pins into the bone (internal fixation) or outside the body (external fixation) to hold bone fragments in place to allow alignment and healing
    • Closed reduction is a non-surgical procedure used to reduce and set the fracture. Using an anesthetic (typically given through an IV), the doctor realigns the bone fragments from outside the body and holds them in place with a cast or splint.
    • Traction corrects broken or dislocated bones by using a gentle and steady pulling motion in a specific direction to stretch muscles and tendons around the broken bone in a specific direction.  This allows the bone ends to align and heal, and in some cases, it reduces painful muscle spasms.
  • Boston Children's Hospital's pioneering research in orthopedics helps provide children with the most innovative care available.

    Clinical research leaders in the Orthopedic Center at Boston Children’s are recognized throughout the world for their achievements. Our orthopedic research team includes:

    • full-time basic scientists
    • more than 28 clinical investigators
    • a team of research coordinators and statisticians

    New trauma/ER database

    Boston Children’s has begun to track and compile data about outcomes in orthopedic ER trauma cases to help us pinpoint the best ways to treat these injuries. Among the details we’re tracking are:

    • type and location of fracture (such as an end-of-the-radius/wrist fracture)
    • how the injury was initially treated
    • whether the injury required admission to the hospital
    • outcome

    The information gathered from this ongoing tracking study will further influence how specialists in Boston Children’s Orthopedic Trauma Program care for children by providing accurate, comprehensive tracking and outcomes data.

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