How can I tell if my child has broken a bone?
Although the term fracture may sound serious, it is just another name for a broken bone. As you probably remember from your own childhood, fractures are very common. In fact, they are the fourth most common injury among children under age six. Falls cause most of the fractures in this age group, but the most serious bone breaks usually result from car crashes.
A broken bone in a child is different from one in an adult, because young bones are more flexible and have a thicker covering, which makes them better able to absorb shock. Children’s fractures rarely require surgical repair. They usually just need to be kept free of movement, most often through the use of a molded cast.
Types of Fractures
Most youngsters, broken bones are either “greenstick” fractures, in which the bone bends like green wood and breaks only on one side, or “torus” fractures, in which the bone is buckled, twisted, and weakened but not completely broken. A “bend” fracture refers to a bone that is bent but not broken, and is also relatively common among youngsters. “Complete” fractures, in which the bone breaks all the way through, also occur in young children.
Because your child’s bones are still growing, he is vulnerable to an additional type of fracture that does not occur in adults. This involves damage to the growth plates at the ends of the bones, which regulate 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, so these fractures must be followed carefully by the pediatrician for twelve to eighteen 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.
Fractures also are classified as “non-displaced,” when the broken ends are still in proper position, or “displaced,” when the ends are separated or out of alignment. In an “open” or “compound” fracture, the bone sticks through the skin. If the skin is intact, the fracture is “closed.”
Signs and Symptoms
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. 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 bone doesn’t necessarily rule out a fracture. Anytime you suspect a fracture, notify your pediatrician immediately.
Until your child can be seen in the pediatrician’s office, emergency room, 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 drink or to relieve pain without first consulting the doctor, but if yours is an older child, 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 his leg, do not try to move him yourself. Call 911 for an ambulance; let the paramedics supervise his 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.
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 necessary.
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, an orthopedic surgeon may have to realign the bones. This may be done as a “closed reduction,” in which the surgeon uses local or general anesthesia, manipulates the bones until they’re straight, and then applies a cast. An “open reduction” is a surgical procedure done in an operating room, but this is rarely necessary for children.
After the surgical reduction, a cast will be used until the bone has healed, which usually takes about half the time that adult bones require, or less, depending on the child’s age. The nice thing about young bones is that they don’t have to be in perfect alignment. As long as they are more or less in the right place, they will remodel as they grow. Your pediatrician may order periodic X-rays while the bone is healing, just to make sure they are aligning properly.
Usually casting brings rapid relief or at least a decrease in 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.
Bones that have been broken often will form a hard knot 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.