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What are fractures in children?

A fracture (broken bone) happens when a child’s bone is placed under more force than it can handle, such as during a fall or accident.

Because children’s bones are still growing, they tend to heal quickly. However, prompt medical care is important to ensure the bone heals properly and to reduce the risk of future problems, such as pain, stiffness, or loss of function.

Symptoms & Causes

What are the symptoms of a fracture?

The signs and symptoms of a fracture include:

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

What are the most common childhood fractures?

What increases a child’s risk of a fracture?

  • Falling from playground equipment or a trampoline.
  • Bike and scooter accidents, including e-bikes and dirt bikes. E-bikes and dirt bikes in particular, have been associated with very severe musculoskeletal injury. 
  • Participation in sports such as football, ice hockey, soccer, and gymnastics.
  • Poor nutrition, including inadequate vitamin D intake.

How are children’s bones different from adult bones?

  • More flexible: Children’s growing bones are flexible and tend to buckle or bend before breaking, leading to unique fracture patterns.
  • Faster to heal: Children’s bones have a thick outer layer of tissue (known as periosteum) that provides blood supply to the bone and promotes healing if the bone is broken.
  • Ability to remodel: Because children are still growing, their bones can “remodel” or naturally correct some deformities that can occur after a fracture.
  • Open growth plates: Children have soft areas of cartilage called growth plates at the ends of their long bones where bone growth takes place. A fracture involving a growth plate can affect how the bone continues to grow and requires careful evaluation.

What are the different types of childhood fractures?

Children’s fractures vary in type and severity, depending on the cause. Even minor fractures need medical treatment to ensure proper healing and prevent future complications. 

  • Torus (buckle) fracture: A dent in the bone that can happen when one side of the bone bends in on itself.
  • Stress fracture (hairline fracture): A small crack in a bone.
  • Non-displaced fracture: A bone is broken, but the ends remain aligned.
  • Displaced fracture: The ends of the broken bone have moved out of alignment.
  • Growth plate fracture: A break that extends into the area of soft cartilage where bone growth takes place.
  • Comminuted fracture: The bone has broken into more than two pieces that no longer line up properly.
  • Compression fracture: A section of bone collapses under intense pressure.
  • Open fractures (compound fracture): Part of a broken bone breaks through the skin. 

Diagnosis & Treatments

How are fractures diagnosed?

At Boston Children’s Hospital, one of our orthopedic specialists will examine your child’s injured limb. If your child has symptoms of a fracture, one or more diagnostic tests will allow our clinicians to examine the bone and confirm that the bone is broken.

  • X-ray, our primary mode of diagnosing bony abnormalities.
  • CT scan, which can give us greater detail of fractures or pick up subtle fractures.
  • MRI, which can pick up minor fractures or stress fractures that may not appear on an X-ray or CT scan.

How are fractures treated?

Your child’s treatment will depend on the type and severity of the fracture as well as your child’s stage of development.

  • Most fractures are treated with a cast, splint, brace, or boot to protect the bone while it heals.
  • If your child has a displaced fracture, we will first perform a procedure called a reduction to realign (set) the bone before placing a cast to hold the bone in place.
  • If your child has a severe or unstable fracture, surgical treatment may be required.  In this case, an orthopedic surgeon will set the bone using rods, screws, pins, or other implants to properly align and stabilize the bone during healing. The procedure will take place in the operating room while your child is under anesthesia.

Many fractures can be evaluated in a clinic setting, such as our Boston Children’s Orthopedic Urgent Clinic. This daily clinic, with locations throughout Greater Boston, is dedicated to treating fractures and other orthopedic injuries that require prompt evaluation but aren’t serious enough to need emergency care.

Proceed to the emergency department or call 911 if your child has a severe injury with deformity of the limb or if you can see bone poking out through the skin.

Why choose Boston Children’s Hospital for pediatric fracture care?

The experts in Boston Children’s Orthopedics and Sports Medicine Department treat thousands of children, teens, and young adults with fractures every year. As specialists in pediatric bone, muscle, and soft tissue injuries, we can diagnose and treat your child’s injury — all in a child-focused environment designed to help your child feel at ease.

Our Orthopedic Urgent Clinic cares for injuries that require prompt medical attention but are not serious enough to need emergency treatment. We offer on-site imaging, casting, and (when necessary) surgical expertise in five locations: Boston, Needham, Peabody, Waltham, and Weymouth.