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Fractures In Children: Types, Causes, Symptoms, And Treatment

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A complete or partial break in a bone is called a fracture. Fractures can be open (compound) where the bone breaks through the skin or closed (simple) with intact skin. Open fractures require emergency medical care since the wound infection and blood loss can negatively impact the healing process.

Read this post to know more about the causes, types, prevention, and outcomes of fractures in children.

Causes Of Fractures In Children

Fractures occur when bones are subjected to force beyond their tolerance limit. The following factors may increase the risk of fractures in children (1).

  • Overuse injuries may cause fracture due to repeated force or impact on a bone
  • Trauma, such as falls, a hit, or sports injury
  • Twisting or rotational movement of the bone
  • Weakened bones due to diseases, such as rickets and osteoporosis
  • Low bone mineral content due to various conditions that cause poor mineralization of bones, such as renal diseases, osteogenesis imperfecta, cystic fibrosis, growth hormone deficiency, and diabetes mellitus
  • Certain neuromuscular disorders, such as arthrogryposis, spina bifida, cerebral palsy, may increase fractures’ risk due to low bone mineral content and joint stiffness
  • Risk-prone behavior, such as not wearing protective equipment during sports, may increase the likelihood of fractures

In rare cases, physical abuse may also be a reason for fracture. Fractures of ribs, clavicle, humeral shaft, vertebrae, and skull are common in cases of abuse. The healthcare provider may ask for additional information and details of injuries to exclude the possibility of child abuse in some fracture cases.

Signs And Symptoms Of Fractures

The following signs and symptoms are usually seen if the bone is fractured (2).

  • Severe pain
  • Swelling, redness, and warmness at the affected area
  • Bone deformity
  • Inability to make movements of the bone
  • Skin bruising

If these symptoms occur after a fall or injury, it could most likely indicate a fracture. You may seek medical care for an exact diagnosis since these symptoms can also be seen in other health issues.

Types Of Fractures

Fractures can be classified into the following ways (3).

  • Open or compound fractures usually involve skin injury since the broken bone may penetrate the skin. There is an increased risk of infection in open fractures, which may also be associated with blood loss.
  • Closed or simple fracture has intact skin.
  • Non-displaced fracture is where the pieces of completely cracked bone remain aligned.
  • Displaced fracture is when the pieces of completely cracked bone are not in place. Surgical treatment is often required to align the bones in such cases.

Types of fractures usually seen in children are (3):

  • Greenstick fracture involves an incomplete fracture on one side of the bone with a bend on the other side.
  • Buckle or torus fracture occurs due to the compression or buckling of the bone on one side. The bone is buckled but not broken.
  • Bow fracture may involve curving (bowing) of long bones due to longitudinal forces. Radius and ulna bones are more likely to get bow fractures.
  • Hairline fractures are cracks in the bone that do not spread throughout the bone.
  • Single fracture is when the bone is broken only in one place.
  • Segmental fracture involves two or more fractures of a bone.
  • Comminuted fracture is when the bone is crushed into pieces or fracture occurs at more than two places.
  • Corner fracture or a bucket-handle fracture has a crescent shape due to fragmentation of the femur bone’s distal end.

The treatment options may vary in each type of fracture, so consult a pediatrician for appropriate treatment.

Prevention Of Fractures In Children

Children are prone to fractures since they are highly active and their bones are in a growing phase. The following precautions may help reduce fracture risk in children and promote bone health (4).

  • Diet rich in calcium and vitamin D helps enhance bone health
  • Exercise helps strengthen the bones
  • Practice sports with standard safety equipment and facilities
  • Wear helmets

Fractures cannot be prevented in many cases. However, safety measures and good bone health may reduce the injury’s severity and promote better healing.

Diagnosis Of Fractures In Children

The following imaging tests are ordered to confirm a fracture if the doctor notices its signs and symptoms (5).

  • X-rays
  • MRI scan
  • CT scan

Health care providers may also ask for more details about the cause of injury and the child’s medical history.

Usually, X-rays are sufficient to diagnose a fracture. MRI or CT scans are ordered if more detailed images of bones and surrounding tissues are needed for diagnosis or treatment.

Treatment For Fracture In Children

Treatment options may depend on the type, severity, and symptoms of the fracture. The child’s age and health status could also be considered. All types of fracture treatment aim to control pain, help bone healing, and prevent complications. Open fractures are treated in emergencies due to deep wounds on the skin.

The fracture treatment may include the following (6).

  • Traction is a treatment involving stretching of muscles and tendons surrounding the bone. It helps align the bone’s ends correctly while they heal. Metal frames, strings, pulleys, or weights are often attached to the bed to keep the alignment all the time during the healing process.
  • A splint or cast immobilization also helps to keep the broken bone in place during the healing process.
  • Braces or functional casts are required for some fractures where limited mobilization is vital for adequate healing.
  • Surgeries, such as internal fixation of the bone, are required in certain fractures. Metal plates, rods, or pins are often used to keep the bone in the correct position while healing.
  • External fixation of fracture uses metal bars and screws to fix the bone from the outside of the skin’s surface.

Medications could be given to reduce pain. Some children may require orthopedic rehabilitation to achieve the complete function of the broken bone after recovery.

Prognosis Of Fractures In Children

Fractures may take several weeks to heal completely in children. However, the healing process may vary in each child based on the type of fracture, the bone involved, and the child’s health status.

Children’s bones heal faster than adults since it has thicker, stronger, and denser periosteum, the bones’ outer membrane, which contains blood vessels that supply oxygen and nutrients. It could help promote rapid healing of bones in children (4).

Growth plate fracture may heal without any long-term effects in many children. Some may have the formation of bridging bone across the growth plate that restricts the bone’s growth. Bridging bones could be surgically removed for normal bone growth.

Fractures in children are often a common occurrence and mostly resolve without any long-term adverse effects. You may have follow-up visits with the doctor based on the recommendations to determine any abnormal growth. Adequate precautions and prevention strategies could help reduce the risk of any bone fractures in children.

References:

1. Approach To The Child With Fractures; The Journal Of Clinical Endocrinology And Metabolism
2. Fracture In Children;; The University of Rochester Medical Center
3. Fractures; Boston Children’s Hospital
4. Fractures In Children;; Johns Hopkins Medicine
5. Fractures In Children;; Lucile Packard Children’s Hospital, Stanford
6. Fractures In Children; The American Society for the Surgery of the Hand

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