Children's Health: Broken Bones

Children's Health: Broken Bones

The harder kids play, the harder they fall. The fact is, broken bones, or fractures, are common in childhood and often happen when kids are playing or participating in sports.

Most fractures occur in the upper extremities: the wrist, the forearm, and above the elbow. Why? When kids fall, it's a natural instinct for them to throw their hands out in an attempt to stop the fall.

Although many kids will have a broken bone at some point, it can be scary for them and parents alike. Here's the lowdown on what to expect.

How Do I Know if It's Broken?
Falls are a common part of childhood, but not every fall will result in a broken bone. The classic signs of a fracture are pain, swelling, and deformity (which looks like a bump or change in shape of the bone). However, if a break isn't displaced (when the pieces on either side of the break are out of line), it may be harder to tell.

Some telltale signs that a bone is broken are:

You or your child heard a snap or a grinding noise during the injury.
There's swelling, bruising, or tenderness around the injured part.
It's painful for your child to move it, touch it, or press on it; if the leg is injured, it's painful to bear weight on it.
The injured part looks deformed. In severe breaks, the broken bone might poke through the skin.


What Do I Do?


If you suspect that your child has a fracture, you should seek medical care immediately.

Do not move your child and call for emergency care if:

your child may have seriously injured the head, neck, or back
the broken bone comes through the skin. Apply constant pressure with a clean gauze pad or thick cloth, and keep the child lying down until help arrives. Don't wash the wound or push in any part of the bone that's sticking out.
For less serious injuries, try to stabilize the injury as soon as it happens by following these quick steps:

Remove clothing from or around the injured part. Don't force a limb out of the clothing, though. You may need to cut clothing off with scissors to prevent causing your child any unnecessary additional pain.
Apply a cold compress or ice pack wrapped in cloth. Do not apply it directly on the skin.
Place a makeshift splint on the injured part by:
keeping the injured limb in the position you find it
placing soft padding around the injured part
placing something firm (like a board or rolled-up newspapers) next to the injured part, making sure it's long enough to go past the joints above and below the injury
keeping the splint in place with first-aid tape
Seek medical care and don't allow the child to eat, in case surgery is needed.

Different Types of Fractures
A doctor might be able to tell whether a bone is broken simply by looking at the injured area. But the doctor will order an X-ray to confirm the fracture and determine what type it is.

Reassure your child that, with a little patience and cooperation, getting an X-ray to look at the broken bone won't take long. Then, he or she will be well on the way to getting a cool — maybe even colorful — cast that every friend can sign.

For little ones who may be scared about getting an X-ray, it can help to explain the process like this: "X-rays don't hurt. Doctors use a special machine to take a picture to look at the inside of your body. When the picture comes out, it won't look like the ones in your photo album, but doctors know how to look at these pictures to see things like broken bones."

A fracture through the growing part of a child's bone (called the growth plate) may not show up on X-ray. If this type of fracture is suspected, the doctor will treat it even if the X-ray doesn't show a break.

Children's bones are more likely to bend than break completely because they're softer. Fracture types that are more common in kids include:

buckle or torus fracture: one side of the bone bends, raising a little buckle, without breaking the other side
greenstick fracture: a partial fracture in which one side of the bone is broken and the other side bends (this fracture resembles what would happen if you tried to break a green stick)
Mature bones are more likely to break completely. A stronger force will also result in a complete fracture of younger bones. A complete fracture may be a:

closed fracture: a fracture that doesn't break the skin
open (or compound) fracture: a fracture in which the ends of the broken bone break through the skin (these have an increased risk of infection)
non-displaced fracture: a fracture in which the pieces on either side of the break line up
displaced fracture: a fracture in which the pieces on either side of the break are out of line (which might require the doctor to realign the bones or require surgery to make sure the bones are properly aligned before casting)
Other common fracture terms include:

hairline fracture: a thin break in the bone
single fracture: the bone is broken in one place
segmental: the bone is broken in two or more places in the same bone
comminuted fracture: the bone is broken into more than two pieces or crushed



Getting a Splint or Cast
The doctor might decide that a splint is all that's needed to keep the bone from moving so it can heal. Whereas a cast encircles the entire broken area and will be removed by the doctor when the bone is healed, a splint usually supports the broken bone on one side.

When the doctor puts on a splint, a layer of cotton goes on first. Next, the splint is placed over the cotton. A splint may be made of stiff pieces of plastic or metal or can be molded out of plaster or fiberglass to fit the injured area comfortably. Then cloth or straps (which usually have Velcro) are used to keep the splint in place. The doctor might need to readjust the splint later.

However, most broken bones will need a cast. A cast, which keeps a bone from moving so it can heal, is essentially a big bandage that has two layers — a soft cotton layer that rests against the skin and a hard outer layer that prevents the broken bone from moving.

Casts are typically made of either:

plaster of paris: a heavy white powder that forms a thick paste that hardens quickly when mixed with water. Plaster of paris casts are heavier than fiberglass casts and don't hold up as well in water.
synthetic (fiberglass) material: made out of fiberglass, a kind of moldable plastic, these casts come in many bright colors and are lighter and cooler. The covering (fiberglass) on synthetic casts is water-resistant, but the padding underneath is not. You can, however, sometimes get a waterproof liner. The doctor putting on the cast will decide whether your child should get a fiberglass cast with a waterproof lining.
Although some kids might find casts cool when they're finally on their broken parts, the process of getting them put there can be scary, especially for a child in pain. Knowing what happens in the cast room might help alleviate some worry — both yours and your child's.

For displaced fractures (in which the pieces on either side of the break are out of line), the bone will need to be set before putting on a cast. To set the bone, the doctor will put the pieces of the broken bone in the right position so they can grow back together into one bone (this is called a closed reduction).

A closed reduction involves the doctor realigning the broken bone so that it heals in a straighter position. The child is given sedation, which is a medicine, usually through an intravenous line (IV) during the closed reduction. Because realigning the bones is a painful procedure, sedation keeps it from hurting during the procedure. A cast is then put on to keep the bone in position. You can expect another X-ray to be taken immediately after the procedure to make sure the bones are in good position after the realignment is done.

So how is a cast actually put on? First, several layers of soft cotton are wrapped around the injured area. Next, the plaster or fiberglass outer layer is soaked in water. The doctor wraps the plaster or fiberglass around the soft first layer. The outer layer is wet but will dry to a hard, protective covering. Doctors sometimes make tiny cuts in the sides of a cast to allow room for swelling.

Once the cast is on, the doctor will probably recommend that your child prop the splinted or casted area on a pillow or stool for a few days to reduce swelling. A child who has a cast on a foot or leg (called a walking cast) shouldn't walk on it until it's dry (this takes about 1 hour for a fiberglass cast and 2 or 3 days for a plaster cast).

If the cast or splint is on an arm, the doctor might give your child a sling to help support it. A sling is made of cloth and a strap that loops around the back of the neck and acts like a special sleeve to keep the arm comfortable and in place. A child with a broken leg will probably get crutches to make it a little easier to get around.

Cast Care
Some pain is expected for the first few days after getting a cast, but it usually isn't severe. The doctor may recommend acetaminophen or ibuprofen. Be sure to ask your doctor which pain medication is preferred. However, if your child seems to be in a lot of pain, call the doctor.

If the cast is causing your child's fingers or toes to turn pale, white, purple, blue, look swollen or feel numb the cast may be too tight or the swelling around the injured area has increased and you should call the doctor right away. Also be sure to call if the skin around the edges of the cast gets red or raw — that's typically a sign that the cast is wet inside from sweat or water.

Also, kids shouldn't pick at or remove the padding from the edges of fiberglass casts because the padding is protective and without it, the fiberglass edges can rub on the skin and cause irritation.

It is important to keep the splint and cast dry. Whether your child has a splint or cast the doctor should give you full instructions on how to care for it.

More Serious Breaks
Although most broken bones simply need a cast to heal, other more serious fractures (such as compound fractures) might require surgery to be properly aligned and to ensure the bones stay together during the healing process.

Open fractures need to be cleaned thoroughly in the sterile environment of the operating room before they're set because the bone's exposure to the air poses a risk of infection.

With breaks in larger bones or when the bone breaks into more than two pieces, the doctor may put a metal pin in the bone to help set it before placing a cast. Don't worry, though — as with any surgery, your child will be given medicine so that he or she won't feel a thing. And when the bone has healed, the doctor will remove the pin.

When Will a Broken Bone Heal?
Fractures heal at different rates, depending upon the age of the child and the type of fracture. For example, young children may heal in as little as 3 weeks, while it may take 6 weeks for the same kind of fracture to heal in teens.

It's important for your child to wait to play games or sports that might use the injured part until your doctor says it's OK.

Preventing Broken Bones
Although fractures are a common part of childhood, some kids are more likely to have one than others. For example, those with an inherited condition known as osteogenesis imperfecta have bones that are brittle and more susceptible to breaking.

Be sure your child is getting enough calcium to decrease the risk of developing osteoporosis (a condition that also causes the bones to be more fragile and likely to break) later in life.

Also, don't forget to motivate kids to get involved in regular physical activities and exercise, which are very important to good bone health. Weight-bearing exercises such as jumping rope, jogging, and walking can also help develop and maintain strong bones.

Although it's impossible to keep kids out of harm's way all the time, you can help to prevent injuries by taking simple safety precautions, such as childproofing your home, making sure kids always wear helmets and safety gear when participating in sports, and using car seats and seat belts for kids at every age and stage.

If your child does get a broken bone, remember that even though it can be frightening, a fracture is a common, treatable injury that many kids experience at one time or another. With a little patience, your child will be back to playing and running around before you know it.

Reviewed by: Yamini Durani, MD