Although the term fracture may sound serious, it is just another name for a broken bone. Fractures are the fourth most common injury among children under age 6. Falls cause most of the fractures in this age group, but the most serious bone breaks usually result from car crashes.
Are broken bones different in children than adults?
A broken bone in a child is different from one in an adult, because young bones are more flexible and have a thicker covering. This makes them better able to absorb shock. Because children's bones are still growing, they have tremendous potential to repair themselves. So, perfect alignment is often not necessary. Many fractures can be treated without surgery. They usually just need to be kept free of movement, most often through the use of a molded cast or splint
Common types of fractures in children
Often children's fractures are either "greenstick" fractures, with the bone bending like green wood and breaking only on one side, or "torus" fractures, with the bone buckled, twisted and weakened but not completely broken.
A bone with "plastic deformation" is a bone that is bent but not borken and is relatively common among children, too.
"Complete" fractures, in which the bone breaks all the way through, also occur in young children.
Growth place fractures
Because your child's bones are still growing, they are vulnerable to an additional type of fracture that does not happen in adults. This involves damage to the growth plates at the ends of the bones, which control future growth. If this part of the bone does not heal properly after the fracture, the bone may grow at an angle or more slowly than the other bones in the body.
Unfortunately, the impact on the bone's growth may not be visible for a year or more after the injury. That's why growth plate fractures must be followed carefully by the pediatrician for 12 to 18 months to make sure no growth damage has occurred.
Fractures that involve injury to the growth plate sometimes need surgery to minimize the risk of future growth problems. Fractures around the elbow often cause the arm to heal abnormally, resulting in a crooked position. Many require surgery to minimize this risk. Children with fractures near the elbow may be referred to an orthopedic specialist.
How can I tell if my child has a broken bone?
It's not always easy to tell when a bone is broken, especially if your child is too young to describe what he's feeling.
Signs & symptoms of a broken bone
Ordinarily with a fracture, you will see swelling and your child will clearly be in pain and unable—or unwilling—to move the injured limb. However, just because your child can move the limb doesn't necessarily rule out a fracture.
Often with a fracture there is tenderness at one spot where the fracture is when you press along the limb. Anytime you suspect a fracture, notify your pediatrician right away. If the limb is crooked, you should seek immediate treatment for your child at the emergency department or urgent care.
First aid for a suspected broken bone
Until your child can be seen in the pediatrician's office, emergency roo, or urgent care center, use an improvised sling or rolled-up newspaper or magazine as a splint to protect the injury from unnecessary movement.
Don't give the child anything by mouth to eat or drink (even pain medicine) before going to the doctor in case they need to be given general anesthia to fix the fracture. For older children, you can use an cold pack or a cold towel, placed on the injury site, to decrease pain. Extreme cold can cause injury to the delicate skin of babies and toddlers, so do not use ice with children this young.
If your child has broken their leg, do not try to move them yourself.
Call 911 for an ambulance; let the paramedics supervise their transportation and make the child as comfortable as possible.
If part of the injury is open and bleeding, or if bone is protruding through the skin, place firm pressure on the wound; then cover it with clean (preferably sterile) gauze. Do not try to put the bone back underneath the skin. After this injury has been treated, be alert to any fever, which may indicate that the wound has become infected.
Medical treatment for broken bones
After examining the break, the doctor will order x-rays to determine the extent of the damage. If the doctor suspects that the bone's growth plate is affected, or if the bones are out of line, an orthopedic consultation will be needed.
Because children's bones heal rapidly and well, a plaster or fiberglass cast, or sometimes just an immobilizing splint, is all that is needed for most minor fractures. For a displaced fracture, where the bones aren't aligned properly, an orthopedic surgeon may have to realign the bones. This may be done without sugery, with an orthopedic surgeon manipulating the bones until they're straight, and then applies a cast.
If the break is more severe, your child may need to be given medication in the emergency department for them to set the fracture, or your child may need to be sedated under general anesthesia in the operating room. After the reduction, a cast will be used until the bone has healed, which usually takes less time than adult bones require.
The nice thing about young bones is that they don't have to be in perfect alignment for them to remodel as they grow. Your orthopedist may order periodic x-rays while the bone is healing, just to make sure they are aligning properly.
Pain, swelling and cast care
Usually casting brings rapid relief or at least a decrease in pain. Your child may experience pain for the first two to three days after the injury, or after setting or surgery. It is important to elevate the broken limb for the first 2 to 3 days to decrease the swelling. Typically, pain can be treated with over-the-counter medications, as well as activities to distract your child from the pain.
If your child has an increase in pain, numbness or pale or blue fingers or toes, call your doctor immediately. These are signs that the extremity has swollen and requires more room within the cast. If the cast is not adjusted, the swelling may press on nerves, muscles and blood vessels, which can produce permanent damage. To relieve the pressure, the doctor may split the cast, open a window in it or replace it with a larger one.
Also let the doctor know if the cast breaks or becomes very loose, or if the plaster gets wet and soggy. Without a proper, secure fit, the cast will not hold the broken bone in position to mend correctly.
What to expect as a broken bone heals
Often, bones that have been broken often will form a hard knot, known as a callus, at the site of the break during the healing process. Especially with a broken collarbone, this may look unsightly, but there is no treatment for this, and the knot will not be permanent. The bone will remodel and resume its normal shape in a few months.
Remember
Broken bones in children are common and, in most cases, heal well with simple treatment. With quick medical care, proper follow‑up and a little patience, most kids make a full recovery and get back to doing what they love—running, jumping and playing.
If you ever suspect your child may have a broken bone, trust your instincts and call their pediatrician.