Fractures are more common in children due to their activities as well as their bone properties. Children are more active than adults and management of fractures in them also differs as compared to that in adults. Fractures occur when the bone is subjected to excessive stress than normal. It is very common in children because of the presence of a growth plate which is the area of the child’s bone that consists of cartilage cells that transform into solid bone as the child grows. Growth plate fractures occur more often because it is the weakest area in the bone.
Children with growth plate fractures may complain of pain and localized tenderness over the growth plate. There may or may not be any swelling or an obvious deformity. Clinical examination and X-rays will be required for diagnosis of a growth plate fracture.
Once your doctor has confirmed the diagnosis of growth plate fracture, the treatment options will be discussed. If there is a non-displaced fracture in which the broken bone ends remain aligned in correct anatomic position, then casting is the treatment option. A reduction will be necessary if the fracture is displaced and this is done under local or general anesthesia. A confirmatory X-ray will be taken to ensure correct positioning of the fracture ends after reduction. In certain cases, surgery may be required to reposition the growth plate fracture into healing position.
Your doctor will schedule a follow-up visit after a few months during which X-rays will be taken to check for normal bone growth. If any growth disturbance or deformity is detected, further treatment becomes necessary.
Other types of fractures
- Torus/buckle fractures: A torus or buckle fracture is one of the most common fractures that occur in children. It is because of end-to-end compression of the bone, which results in buckling or giving way of the sides of the bone.
- Greenstick fractures: This is a unique fracture in children that involves bending of one side of the bone without any break in the bone.
- Toddler fracture occurs in young children when there is injury to the tibia (shin bone). This fracture is not evident on an X-ray as they are undisplaced.
- Nursemaid elbow occurs when there is displacement of one of the bones (radius) in the elbow joint. It usually occurs in children younger than 5 years.
Early fracture management is aimed at controlling bleeding, preventing ischemic injury (bone death) and removal of sources of infection such as foreign bodies and dead tissue. The next step in fracture management is the reduction of the fracture and its maintenance. It is important to ensure that the involved part of the body returns to its function after fracture heals. To achieve this, maintenance of fracture reduction with immobilization technique is done by either non-operative or surgical method.
Non-operative (closed) therapy comprises of casting and traction (skin and skeletal traction).
Closed reduction is done for any fracture that is displaced, shortened, or angulated. Splints and casts made up of fiberglass or plaster of Paris material are used to immobilize the limb.
Traction method is used for the management of fractures and dislocations that cannot be treated by casting. There are two methods of traction namely, skin traction and skeletal traction. Skin traction involves attachment of traction tapes to the skin of the limb segment below the fracture. In skeletal traction, a pin is inserted through the bone distal to the fracture. Weights will be applied to this pin, and the patient is placed in a setting that facilitates traction. This method is most commonly used for fractures of the thighbone.
- Open Reduction and Internal Fixation (ORIF)
This is a surgical procedure in which the fracture site is adequately exposed and reduction of the fracture is done. Internal fixation is done with devices such as Kirschner’s wires, plates and screws, and intramedullary nails.
- External fixation
External fixation is a procedure in which the fracture stabilization is done at a distance from the site of the fracture. It helps to maintain bone length and alignment without casting.
External fixation is performed in the following conditions:
- Open fractures with soft-tissue involvement
- Burns and soft tissue injuries
- Pelvic fractures
- Comminuted and unstable fractures
- Fractures having bony deficits
- Limb-lengthening procedures
- Fractures with infection or nonunion
Fractures may take several weeks to months to heal completely. Children should limit their activities even after the removal of the cast or brace so that the bone becomes solid enough to bear the stress.
Pediatric Forearm Fractures
The radius (bone on the thumb side) and ulna (bone on the little-finger side) are the two bones of the forearm. Forearm fractures can occur near the wrist, near the elbow or in the middle of the forearm. Apart from this, the bones in children are prone to a unique injury known as a growth plate fracture. The growth plate, which is made of cartilage (flexible tissue) is present at the ends of the bones in children and helps in the determination of length and shape of the mature bone.
The healing of fractures in children is quicker than that in adults. Thus, if a fracture is suspected in a child, it is necessary to seek immediate medical attention for proper alignment of the bones.
Types of fractures
Forearm bones may break in many ways. Fractures may be “open” where the bone protrudes through the skin, or “closed” where the broken bone does not pierce the skin.
The common types of fractures in children include:
- A stable fracture that compresses the bone on one side, forming a buckle on the opposite side of the bone, without breaking the bone (Buckle or torus fracture)
- One side of the bone breaks and bends the bone on the other side (Greenstick fracture)
- Displacement of the radius, and dislocation of the ulna at the wrist where both bones meet (Galeazzi fracture)
- Fracture affecting the upper or lower portion of the bone shaft (Metaphyseal fracture)
- Fractured ulna and dislocated head of the radius (Monteggia fracture)
- Fracture occurring at or across the growth plate (Growth plate fracture)
Forearm fractures in children are caused due to a fall on an outstretched arm or direct hit on the forearm, which may result in breakage of one or both bones (radius and ulna).
Signs and Symptoms
A fractured forearm causes severe pain and numbness. Other signs and symptoms include:
- Inability to turn or rotate the forearm
- Deformed forearm, wrist or elbow
- Bruising or discoloration of the skin
- Popping or snapping sound during the injury
Forearm fractures in children can be diagnosed by analyzing X-ray images of the wrist, elbow or the forearm.
The treatment of forearm fractures in children is based on the location, type of fracture, degree of bone displacement and its severity.
Your child’s doctor will advise you to apply an ice pack over a thin towel on the affected area for 15-20 minutes 3-4 times a day, to relieve pain and swelling. For severe angled fractures, in which the bones have not broken through the skin, your doctor will align the bones properly without the need for surgery (closed reduction). A splint or cast may be required for 3 to 4 weeks for a stable buckle fracture. Immobilization for 6 to 10 weeks is recommended for more serious fractures.
Surgery may be necessary for severe fractures such as fractures of the growth plate or the joint. Other conditions, such as broken skin, bone displacement, unstable fractures, misaligned bones, and bones healing in an improper position may also require surgical repair. Your surgeon will first align the bones through an incision and use fixation devices like pins or a metal implants to hold the bones in place while the wound heals. A cast or a splint may be placed to hold the bones in place.