Child bone fracture

Last updated date: 17-Jun-2023

Originally Written in English

Child bone fracture

Overview

Fractures range in severity from moderate to severe, with surgical treatment not always necessary. The good news is that fractures in youngsters heal quickly. The younger your child, the faster he or she will recuperate. Because children's bones are still developing, they are softer and more flexible. Their bones will buckle or bend before shattering altogether. However, stresses applied to bones might be excessive, and the bones will occasionally break, necessitating medical attention

 

How are a child’s bones different from adult bones?

child’s bones

Children's bones develop throughout their youth. This capacity for development enables children's bones to "remodel," or spontaneously rectify part or all of the deformities created by a fracture. Children's bones shatter in different ways than adult bones because they are developing.

    1. Children’s bones are more flexible

Growing bones sometimes buckle or flex before breaking, resulting in unusual fracture patterns. A greenstick (bending) fracture, for example, can occur when one side of a bone bends. Alternatively, one side of the bone may bend and become dented, resulting in a buckle fracture.

    2. Children have vulnerable growth plates

Development plates are soft regions of cartilage at the ends of children's bones where growth occurs. When a kid experiences a fracture, certain regions of growth are frequently jeopardized. Injury to growth plates can occur at any stage of development, although it is more prevalent in early adolescence, when growth plates are nearing completion.

    3. Children’s bones heal faster

A thick covering of connective tissue (referred to as periosteum) surrounds a child's bones and protects them from damage and fracture. This tissue supplies blood to the bone. When a bone fractures, the body uses this blood supply to repair injured cells and mend the bone. As youngsters get older, their periosteum thins out and provides less support. This is why adult bones mend slower than kid bones.

 

What are the symptoms of a fracture in a child?

 fracture in a child symptoms

Symptoms may manifest differently in each child. If your child fractures a bone, the following are the most typical symptoms:

  • Pain
  • Swelling
  • Obvious deformity of the bone
  • Trouble using or moving the bone in a normal way
  • Warmth, bruising, or redness

These symptoms may appear to be related to other health issues. Make an appointment for your child to visit a doctor for a diagnosis.

 

Types of Pediatric Fractures

Pediatric Fractures

           1. Incomplete fractures

An incomplete fracture occurs when just one side of the bone is shattered and the other side either stays intact or bends slightly but does not completely break into two pieces.

           2. Torus, or “buckle” fractures – The most common fractures in children are torus fractures. They commonly occur around the wrist when youngsters fall and attempt to catch themselves.

           3. Greenstick fractures – Greenstick fractures earn their name because they are akin to trying to shatter a small living tree branch. The bone will shatter on one side, but the other will stay linked but bendable. Depending on the angle of the fracture, greenstick fractures are treated with closed reduction or surgery.

         4. Plastic, or “bending” deformities – Because children's bones are more malleable than adults', they might acquire some bending or curving to a bone without a visible fracture line. These are nonetheless treated as fractures in order to let the bone reset properly.

           5. Complete fractures

When both sides of the bone are shattered in two, this is referred to as a complete fracture. Complete fractures are intrinsically less stable and require more complex treatment and constant monitoring to heal in the desired alignment. 

           6. Transverse – Transverse fractures occur straight across or perpendicular to the length of the bone.

           7. Oblique – Oblique fractures cause the bone to crack at an angle.

           8. Comminuted – Comminuted fractures cause the bone to break into more than just two pieces.

 

Greenstick fractures 

Greenstick fractures 

The pediatric skeletal system's constitution, morphology, and histology are not simply a smaller version of the adult form; rather, it is distinctive in that it allows for fast growth and change from childhood to maturity. The open physis in the pediatric population allows for continuing development prior to skeletal maturity throughout puberty and adulthood, which accounts for the bulk of variations between adult and pediatric skeletal systems.

The physis is the growth plate in long bones such as phalanges, fibulae, tibiae, femurs, radiuses, ulnae, and humeruses. It allows for bone formation from a cartilage substrate, a process distinct from bone growth from mesenchymal tissue, or intramembranous ossification. The physis is towards the end of the long bone, with the epiphysis above and the metaphysis under it. Long bones, such as the femur, have two physes separated by a diaphysis, or long bone shaft. Long bones, such as the phalanges, have only one physis.

The calcified cartilage degrades, allowing vascular penetration as well as osteoblastic/osteoclastic bone matrix formation and remodeling. As a result, prior to ossification, the bulk of juvenile bone is merely calcified cartilage, which is far more compliant than adult ossified bones. Pediatric bones are more prone to bowing and bending damage under stress than adult bones because of their higher compliance.

 Furthermore, the pediatric periosteum is more active, thicker, and stronger, lowering the risk of open fractures and fracture displacement. These and other characteristics of the pediatric periosteum, as well as the higher compliance of juvenile bone, are responsible for the distinctive fracture patterns found in pediatric patients. Greenstick, torus, and spiral injuries are examples of bending injuries rather than full thickness cortical fractures.

A greenstick fracture is a partial thickness fracture in which the cortex and periosteum are interrupted on one side of the bone but not on the other.

 

Symptoms of greenstick fractures 

Patients with greenstick fractures have the same history and physical exam as patients with other forms of fractures. Age, gender, anatomic location, soft tissue involvement (open versus closed evaluation), and mode of injury are all crucial aspects of the history. A physical exam must include location, soft tissue involvement, and neurovascular health. In addition, the joints under and above the location should be checked for concealed fractures or multiple fractures.

Findings on the past often involve FOOSH, but can also include history such as getting hit with a baseball bat or other item, as well as other types of unintentional trauma. Non-accidental trauma, on the other hand, should always be considered. Depending on the patient's age, he or she may refuse to move the damaged limb, weep inconsolably, complain of discomfort in the wounded extremity, or be protective of the injured extremity.

Reduced range of motion, discomfort on palpation, and ecchymosis across the damaged area are all common physical findings. Edema, tenting if displaced, soft tissue abnormalities such as abrasion or laceration, and evidence of neurovascular bundle damage are more serious findings. When examining a distal forearm, look for signs of median nerve damage, which can occur with greenstick fractures. All severe injuries should be subjected to a thorough neurological examination. Multiple injuries and ecchymoses at various stages of recovery that do not follow an age-appropriate damage pattern are further signs of non-accidental trauma.

 

Evaluation of Greenstick Fractures

An x-ray of the damaged extremity or region of complaint is part of the diagnostic examination. Typical x-ray findings show a bending injury with a fracture line that does not penetrate the bone entirely. A periosteum and cortex fracture on one side (the tension side) does not spread to the opposite side of the cortex and periosteum. An x-ray shows a visible fracture on the tension side, with plastic deformation owing to compressive pressures on the opposite side of the bone.

 

Greenstick Fractures Management

If there is substantial angulation, the healthcare professional must conduct a closed reduction and immobilization. All greenstick fractures necessitate immobilization, and casting many days after the initial injury reduces the chance of recasting owing to post-fracture edema. Orthopedic referral during the initial appointment is typically advised, however it is dependent on the child's degree of angulation and age.

Long bone greenstick fractures should be immobilized with a cast for six weeks. The type of cast used is determined by the location of the fracture. Distal fractures can be treated with short arm casts, but proximal fractures need long arm casting and can be transferred to a short arm cast around three weeks into the healing period. Patients with proximal fractures require more frequent orthopedic evaluation. However, because of their unstable nature and higher chance of refracture and displacement as compared to buckle or plastic bending injuries, all greenstick fractures should undergo some form of orthopedic follow-up.

Although it is less common, greenstick fractures can be treated with splinting if there is just a minor amount of angulation and diligent follow-up with the patient or family. Splinting may be less expensive and allow the splint to be removed for showers.

 

"Buckle" fractures

Buckle fractures

The juvenile skeleton has distinct features that result in disease that differs from that of the adult skeleton. The existence of the physeal growth plate and a thicker periosteum with softer underlying bone are two important variations. Minor injuries to soft, flexible bone with a thick protective periosteal coating can result in a range of abnormalities with or without a cortical break. Injuries to long bones that do not result in a cortical break either result in plastic deformation by microfracture or in a 'kink' within the long bone, referred to as a 'buckle' or 'torus' fracture.

The fracture site appears on plain X-ray as two outcroppings of bone, as if the long bone had collapsed or 'buckled.' This look also resembles the horns of a bull when viewed from above, thus the alternate name 'torus' fracture. If there is a cortical breach, the fracture is called a greenstick fracture if it is unicortical, or a complete fracture if it is bicortical.

Buckle fractures are extremely common injuries that come to the emergency room, and they are almost usually treated conservatively and do not require orthopedic intervention.

 

Buckle Fractures Management

Buckle Fractures Management

In buckle fractures, the treatment aims are patient comfort and parental reassurance. These are fundamentally stable injuries that generally never require additional treatment. Following an appropriate history and physical examination, if the necessary X-rays demonstrate an isolated injury, the treatment is with detachable wrist splints, a pre-fabricated removable cast, or a soft cast that may be removed once at home by the parents once the therapy is completed. Because these fractures are considered stable, splinting/casting is generally only required for two to three weeks.

Evidence from randomized controlled trials has revealed that detachable splints are the best treatment since they are easier to use for everyday activities, improve physical function, and are typically favored by patients and parents than below elbow casting. As a result, these patients can be securely discharged after receiving adequate parental counseling on removing the splint/soft cast and avoiding any contact sports or harmful activities for six to eight weeks following injury.

Ideally, the above-mentioned therapy is provided in the emergency room, and the patient is discharged; nevertheless, in many circumstances, patients are transferred to fracture clinics for further evaluation.

 

Growth plate fracture

Growth plate fracture

The physis is the name given to the bone's growing plate. A physis may be found on almost every bone. The physis is a kind of cartilage that is found around the ends of the long bones. Because cartilage is not calcified, it appears on X-rays as a black line in the bone. The physis promotes bone growth in both length and breadth. When a child's growth slows, the physis solidifies into solid bone. Boys typically finish developing around the age of 16, and girls around the age of 14, however this varies widely. 

Because cartilage is softer than hard bone, physeal fractures are common. The physis is actually weaker than the ligaments that link the two bones in a joint. Fractures through the physis heal rapidly because the physis is extremely active (it helps the bone develop). If there is a fracture through the physis, it is critical that your kid consult an orthopaedic doctor within the first 5 to 7 days following injury. If the bone needs to be handled, after 10 days the bone may have healed so much that it cannot be moved. 

Physeal fractures are prevalent in children, accounting for 15-30% of all fractures. Fingers, wrists, and lower legs are common fracture sites. These are most commonly caused by acute trauma, although stress fractures in the growth plate can also be observed with prolonged usage, as in gymnasts and pitchers. Because of the possibility of growth difficulties, it is critical that your kid consult an orthopedic expert if there is a physeal fracture.

 

Forearm Fractures in Children

Forearm Fractures in Children

The forearm is the portion of the arm that is located between the wrist and the elbow. It is composed of two bones: the radius and ulna. Forearm fractures are prevalent in children, accounting for more than 40% of all fractures in this age group. In youngsters, three out of every four forearm fractures occur near the wrist end of the radius.

Forearm fractures are common in youngsters while they are playing on the playground or engaging in sports. If a youngster falls and hits his or her outstretched arm, he or she may get a forearm fracture. Because a child's bones mend faster than an adult's, it is critical to treat a fracture as soon as possible—before healing begins—to minimize future complications.

There are several types of forearm fractures in children:

  • Torus fracture. This is known as a "buckle" fracture. Because the uppermost layer of bone on one side of the bone is squeezed, the other side bends away from the growth plate. This is a stable fracture, which means that the shattered bone fragments are still in place and have not separated (displaced).
  • Metaphyseal fracture. The fracture runs through the upper or lower section of the bone shaft and does not damage the growth plate.
  • Galeazzi fracture. This damage affects both forearm bones. At the wrist, where the radius and ulna meet, there is generally a displaced fracture in the radius and a dislocation of the ulna.
  • Monteggia fracture. This damage affects both forearm bones. The ulna is frequently fractured, and the top (head) of the radius is dislocated. This is a serious injury that needs immediate medical attention.
  • Growth plate fracture. This fracture, often known as a "physeal" fracture, occurs at or across the growth plate. In most cases, this sort of fracture develops in the radius's growth plate at the wrist. Because the growth plate influences the length and structure of the mature bone, this sort of fracture requires immediate care.

 

What are the treatments for a fractured bone?

fractured bone treatment

Treatment will be determined by the kind of fracture, its severity, and the age of your kid. Fractures in children are often treated with a sling, splint/brace, cast, or walking boot. These keep the damaged bone immobile as it heals.

 

Splints

If a doctor is concerned about swelling, he or she will typically apply a splint to a recently broken bone. A cast may grow overly tight and restrict blood circulation if the wounded region expands. Once the swelling has subsided, the splint is usually replaced with a cast. Splints are also utilized for small fractures that do not need the insertion of a cast.

 

Boot

An Aircast® boot can help to support a fractured ankle, foot, or leg. The Aircast boot immobilizes the foot and ankle but can be removed under certain conditions for washing or icing. Depending on the severity of the break and the stage of healing, it may be safe to remove the boot for brief periods of time to ice or bathe.

 

Casts

Casts are more durable than splints and offer greater protection to the wounded region. Casts are composed of two layers: a soft inner layer that rests against the skin and a hard outer covering that protects the broken bone and limits movement while it heals. The sort of cast utilized will be determined by the nature of the fracture. 

 

Reduction

A reduction is a non-surgical process that is used to set the bone so that it can mend properly. The doctor realigns the shattered bone from outside the body and casts or splints the afflicted limb. Reductions are often performed in an emergency room using drugs that control pain while also making your kid tired or drugged so they don't recall the process.

 

Surgery

Surgery is required for severe or unstable fractures that cannot be successfully set with a reduction. Your child's doctor will determine whether to operate early in therapy to maximize the odds that the bone will mend in the proper place. However, if the region around the fracture is inflamed, the surgery may have to be postponed until the swelling subsides.

In the operating room, the youngster will be sedated or under general anesthesia while the doctor places the bone. A pin can be used to hold the bone fragments in place while the bone heals. If a joint is fractured, the surgeon will realign the joint and secure it with screws, a plate, or a pin.

  • Other treatments.
  • Traction is a mild, continuous tugging motion in one direction that allows the shattered bone ends to align and heal. Traction might help with unpleasant muscular spasms in some circumstances.
  • Medication is occasionally used to control pain and muscular spasms. Antibiotics are used to prevent infection while a fracture is open.

 

Conclusion 

A child bone fracture is a medical condition in which a bone of a child is cracked or broken. The fractures that are most common in children are incomplete fractures; these fractures are the greenstick and torus or buckle fractures. Treatment for a fracture follows a simple rule: the bones have to be aligned correctly and prevented from moving out of place until the bones are healed