When your child breaks a bone for the first time, it can be frightening for both you as well as your child. There are a few basic things you can do before contacting a pediatrician or going to an urgent care clinic. One is to follow the first three steps of RICE method:
- Do not move the affected area.
- Make a splint to support the bones and protect the injury from being jostled.
- Apply an ice pack for 15-20 minutes at a time to reduce discomfort and swelling. Avoid applying ice to infants or toddlers because extreme cold can injure their delicate skin.
- Avoid the use of artificial cold packs and instead use crushed or cubed ice or frozen peas.
- Never sleep with ice on the injured area.
- Elastic wrap or a compression sock can be used to reduce swelling.
- Apply the wrap below the injured area and wrap upward.
- Always leave the toes or fingers exposed.
- Watch for numbness, discoloration, or temperature changes (loosen wrap if needed).
- Do not sleep with wrap still covering the injured area.
Broken bones are a typical childhood injury, and the good news is that they mend considerably faster than broken bones in adults.
What are treatment options for a broken bone in a child?
X-rays are required for diagnosis and treatment selection. The younger the child, the more years of growth they have left, and the more likely it is that an angulated (or crooked) bone will straighten out with normal growth.
Treatment options for a broken bone in a child include:
Cast or splint
When a forearm fracture involves a bone break that is further rotated, or displaced, the broken bone(s) can often be treated with a plaster splint or cast. Splints offer less support than a hard cast but allow for more swelling. If used initially, these are often replaced with a hard fiberglass cast once the swelling has subsided. For a broken forearm, the cast must include both the elbow and wrist.
Fractures typically heal over the course of 6 weeks. However, this can vary depending on the location, severity, and age of the child. It can take up to 3 months for older children with more shifted fractures to heal.
Bones can crack and become displaced in some forearm fractures. When a forearm fracture bends, rotates, or shifts, the bones may need to be “set” to realign and allow for maximum healing. If a forearm bone heals in a bent position, it can impede forearm rotation (ability to turn the palm up and down).
Some displaced fractures will straighten out with time, particularly in younger children under age 5. Older children may benefit from having the bone straightened by manipulating it in the clinic or operating room.
Once the bone has been set, a plaster splint or fiberglass cast is put to keep the fracture in place while the child recovers.
More serious fractures with significant displacement (bend, rotation, or shifting of the bones) may be treated surgically on occasion.
When the bone cannot be set or the child is over 10 years old, surgery may be required. By the time a child reaches ages 13-15, the growth of the forearm is nearly complete. Older children have less growth remaining and less capacity to correct a displaced bone. Furthermore, as a child grows older, the periosteum (soft coating around the bone) thins and provides less stability. The bone is more likely to shift or displace during healing if the periosteum is thinner.
Forearm fracture surgery often involves the placement of a thin metal (titanium) plate and screws to keep the bone straight. One advantage of surgery is that it can speed up the healing process. As the metal plate and screws hold the bones in place while the body heals the break, children can often begin using the arm for moderate activities 2-3 weeks after surgery.
In the event of severe injury, for example, if a portion of the region is exposed and bleeding or if the bone is protruding through the skin, apply firm pressure to the wound and cover it with clean (ideally sterile) gauze. Do not attempt to reposition the bone beneath the skin. After obtaining care, keep an eye out for fever, which could suggest that the wound has become infected. It is critical that you do not attempt to transport your child alone if you suspect a broken bone. Call 9-1-1 and let the paramedics supervise your child's journey and make them as comfortable as possible.
What are growth plate fractures?
Growth plate fractures are a common type of injury. The majority of growth plate fractures cause no difficulties. However, sometimes the fracture injures enough of the growth cartilage to prevent it from growing properly.
Growth plates are regions of cartilage found near the ends of bones that are especially fragile because they represent the final stage of development in children. The growth plate, which dictates the future shape and length of bone, is responsible for 15%-30% of childhood fractures. Due to the fragile nature of this part of the skeleton, a growth plate fracture can occur rather suddenly, typically from events that would only induce joint sprains in adults.
Signs and symptoms of a growth plate injury are the same as those of a broken bone and include:
- Pain or discomfort
- Inability to bear weight or apply pressure to the limb
- Inability to move the limb
Causes of growth plate injuries and fractures include:
- Falling or twisting
- Contact sports such as football or basketball
- Skiing, skateboarding, or sledding
- Gymnastics, track and field, or baseball
Other possible causes include:
- Extreme cold exposure
- Medical diseases that affect bone growth such as bone infection (osteomyelitis) and tuberculosis of the bone
- Medications that can affect bone growth, such as arthritis or cancer treatment
Treatment is determined by the type of fracture and severity of the damage. Most of the time, splinting or casting is all that is required, followed by rest. If the bones are out of place, they must be properly aligned using a method known as a reduction. There are two types of reductions:
- Closed reduction: A closed reduction is the process of repositioning the bones without operating or making any incisions. The skin is still closed.
- Open reduction: An open reduction involves surgery, as well as potential plates, pins and/or screws. This is performed under general anesthesia. The bones are immobilized by a cast or splint, with the arm/leg resting for an extended period.
Because a child's bones recover quickly, a growth plate fracture examination by a pediatric orthopedic physician within 5-7 days of the accident is critical so that the right therapy can be prescribed before healing begins. Most growth plate injuries heal without consequences with accurate diagnosis and treatment, but if left untreated, persistent injury may impede the proper growth of the affected limb.
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What is the difference between broken bones in children vs. adults?
Children and adults heal differently after a bone break or fracture. It all comes down to how strong our bones are, how our bones are structured, and the type and severity of the fracture.
Children’s bones are thicker and stronger
A child's bones contain considerably more periosteum, a dense coating of vascular connective tissue that covers their bones. This not only makes their bones thicker and stronger but also means they recover and mend considerably faster. This is because the bones are significantly more oxygen-rich, allowing them to recover more quickly after trauma.
However, because of the thickness of children's bones, it is much more difficult to diagnose tiny fractures. Therefore, if your child complains of discomfort following an accident or fall, you should seek medical assistance as soon as possible.
Children heal faster
Children’s bones typically recover faster than those of adults. The time needed for children's bones to mend is usually measured in weeks rather than in months, as it is for most adults.
Unlike adult bones, children's bones are still growing, so their growth pattern can more easily accept broken or fractured bones.
The sooner the bone can be set back in place, the better because you'll want to get it back in place before it begins to heal.
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