Understanding Broken Bones in Children

What are the common types of bone fractures in children?

Most childhood fractures result from mild to moderate trauma that happens while at play or during sports. The arms are the most common location for fractures.

Other common fractures in children include:

• **Broken elbow.**Supracondylar fractures (elbow fractures or monkey bar fractures) can be common especially for children between the ages of 4 – 7.
• Broken collarbone or shoulder. A collarbone fracture is common after a collision or fall onto the shoulder. This can happen in sports or when a child falls from playground equipment or out of bed.
• Broken wrist. Wrist fractures are the most commonly broken bone in the arm. The most common type involves the larger bone in the forearm (radius). It often occurs when a child falls on an outstretched hand that is extended backward or among those who play contact sports, biking and skiing.
• Broken thighbone. The thighbone is the longest, largest, heaviest and strongest bone in the body therefore a fracture in the thighbone only occurs when it comes under significant force. Nevertheless, a fractured thighbone in children is not uncommon.
• Broken knee. Knee fractures can involve the kneecap, or the shin bone or the thigh bone where they join with the knee. It is commonly caused by falling on the knee or car accidents.
• Broken ankle. Ankle fractures in children usually involve the tibia and fibula, the 2 long bones that make up the ankle joint. Many ankle fractures occur when a child's leg is planted in place and suddenly twisted, such as in football, hockey and basketball. It can also be caused by falls from trampolines or swings.

If you think your child may need treatment for a bone fracture, speak to an orthopaedic specialist.

How do I differentiate a simple sprain from a broken bone?

In both a sprain and a broken bone, there is pain, swelling and difficulty moving the injured area in a normal manner. With a broken bone, it may be accompanied by other symptoms.

Symptoms of a child fracture or broken bone

• Deformity (unusual shape) of the bone
• Difficulty placing weight on the area
• Persistent bruising, warmth or redness

What causes fractures in children

Fractures occur when the bone is subjected to more force than it can absorb. Bones are weakest when they are twisted. Overuse injuries, falls, trauma or a direct hit to the body can all cause bones to break.

Child fracture risk

Fractures are commonly associated with the following factors:

• Sport accidents
• Falls from heights
• Accidents
• Poor nutrition
• Low calcium diet
• Obesity

There are some steps you can take to reduce your kids' risk of getting a broken bone.

• Ensure that they put on the right protective equipment when they are taking part in any games or outdoor activities.
• Calcium and vitamin D are the building blocks for healthy bones. Having a healthy diet will ensure that they get these minerals in sufficient amounts.
• Limit carbonated beverages and soda for healthy bones.
• Encourage your kids to be active and to take part in a variety of sports. Playing a single sport all year round puts repeated stress on the same bones and joints and therefore increases risk of overuse injuries.

Child fracture diagnosis

Your doctor will first evaluate the area of injury and ask about how the injury happened. They may also check if your child is able to move the injured limb. Sometimes they may be able to diagnose based on your child's symptoms. Typically, one of the following scans may be needed to confirm the diagnosis: 

• X-rays. The most commonly ordered scan to diagnose fractured bones.
• MRI. This scan may be ordered for fractures in the growth plate – an area of soft tissue – that may not show up on X-rays.
• **CT scan. **A CT scan provides three dimensional imaging. It is preferred for assessing head injuries, and spine and pelvic fractures.

What are the immediate steps to take if I suspect that my child has a fracture of the bone?

Seek medical care immediately if your child displays any symptoms of a fracture.

Apply a cold compress wrapped in cloth. Stabilise the injury as soon as it happens by keeping the injured limb in the position you find it.

An orthopaedic specialist can make a diagnosis with a clinical examination and an x-ray.

How are fractures in kids treated?

A child's growing bones are bendable and resilient. Children's bones heal fast and remodel very well after injury.

Fractures in kids are commonly treated with the following:

• Splint or cast. Almost 90% of kids' fractures are treated in a cast splint to keep the fractures from moving. Stabilising the fractures allows the bone to heal better.
• Medicine. Fractures are usually painful. Certain over-the-counter pain medicine such as paracetamol or ibuprofen or a prescription medicine recommended by your child's doctor can help ease the pain.
• Traction. A traction may be used to gently realign a broken bone back into position by using weights, pulleys and ropes. The kind of traction used will depend on the location and severity of the broken bone and the amount of force needed. These days it is a less common option and is used primarily as a temporary measure until surgery is performed.
• Surgery. Your child may need surgery for certain types of fractures. Most of the time, it is sufficient to fix some wires to hold the bone in place and apply a cast. This helps the bones heal in the correct position.

When a child is in a cast, they are still mobile and able to still attend school.

What is the usual recovery time after a fracture?

A typical uncomplicated fracture in a child heals within 3 – 4 weeks. Most of the time a repeat x-ray is taken after 6 weeks.

How are child fractures different from adult fractures?

There are 2 types of fractures in adults. They are:

High-energy trauma like sports injury or road traffic accidents in younger patients.

In older or elderly patients, low energy trauma may produce fractures because the bone is osteoporotic (weak bones). The vulnerable areas are the wrist, spine & hip.

Treatment of fractures in adults

Adult fractures are treated differently – they may require surgery if they are displaced or angulated. Simple fractures can be treated in a cast.

More complicated fractures may need surgery to fix the fractures. This may be done with metallic plates and screws.

Osteoporotic patients who are elderly or have low bone mass need medication to build up the bone strength.

Speak to an orthopaedic surgeon if you seek treatment for a complicated bone fracture.