Fracture (cont.)
Fracture in children
Children can break bones and yet have normal x-rays. Fractures appear as
clear lines through the bone on an x-ray through the bone. If calcium
hasn't yet accumulated in the repairing bone, the break may not be apparent. This lack of calcification happens in
two ways.
- Bones mature at different times in a child's development and while the
bony structure is there, it may have more cartilage than calcium.
- The second
situation is associated with growth plates. Each bone has an area where cell
activity is maximal and where the bone grows. These areas appear as lucent lines
on x-ray. It may be one of the weaker points in the bone as well, and a fracture
through the growth plate may not be seen.
The doctor needs to match the history and physical exam with what is seen on
x-ray to make to a diagnosis. Sometimes, the child is placed in a cast for a
period of time to protect the broken limb. As fractures heal, the body lays down
extra calcium as building material and then remodels it to normal shape. After
7-10 days, there may be evidence on x-ray of the healing calcium to confirm the
fracture.
Growth plate fractures are classified by Salter-Harris category. When a break
occurs through the growth plate, it can involve different parts of the bone on
each side of the plate. It is important that these fractures are aligned
properly so that the bone grows properly as the child ages. For more, please read the Growth Plate Fractures in Children article.
Children are more flexible than adults until the calcium completely solidifies
their bone. If you think of an arm or leg bone as tubular, sometimes only one
side of the bone breaks, just like an immature branch on a tree. This is
referred to as a greenstick
fracture, and may need to be "set" so that it heals properly. Sometimes the bones can bend but not break because they are so
pliable. This is called a plastic deformity and again will need to be set or
aligned to allow proper healing.
Next: How is a fracture diagnosed? »
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