Children’s Health: Common fractures and their management

A fracture is a break in the continuity of a bone. A pediatric fracture is a condition in which the bone of a person below the age of 18 years is cracked or broken. Fractures in children differ from that in adults because the bones in a child are still growing. Due to this fact, pediatric fractures need more consideration because it can affect the growth of the child.

Bones are made to support certain forces, however, if the force applied is too much than the bone can absorb a fracture occurs. This force can be in the form of a fall, trauma or direct blow or kick to the body. Just as fractures in children differ from those that occur in adults, the bones of a child differ from those in an adult. They differ in many ways such as:

  1. A child’s bone will heal much faster than an adult bone. The younger the child, the faster the healing. This is because a thicker, stronger and more active dense fibrous membrane which is known as the periosteum covers the surface of the child’s bone and this causes a better supply of oxygen and nutrients to the bones. It also causes a more rapid union of the bones in a fracture.
  2. The bones in a child are softer and tend to bend rather than break completely.
  3. In children, there are open growth plates which are called epiphysis and they are located at the end of long bones. This is an area where the bone grows.

 

TYPES

There are two main types of fractures in children and these are incomplete and complete fractures. Incomplete fractures are the most common type of fractures in children.
The types of incomplete fracture include:

  • Greenstick fracture – In this type of fracture,  there is a bend on one side of the bone which causes a partial break on the other side. It has been given this name in comparison to green wood which similarly breaks on the outside when bent.
  • Torus/Buckle fracture – In this type of fracture, the break occurs at the metaphyseal locations which is the narrow portion of a long bone between the epiphysis and diaphysis. It has been named so because it resembles the torus or base of a pillar in architectural terms.

 

The types of complete fracture include:

  • Closed fracture – The bone is broken but does not communicate with the skin; the skin is intact.
  • Open (Compound) fracture – The broken bone penetrates the skin and in this type of fracture there is an increased risk of infection.
  • Non-displaced fracture – The bone breaks completely and the pieces line up in this type of fracture.
  • Displaced fracture – The bone breaks completely in two or more pieces. The pieces do not align and this type of fracture usually requires surgery to make sure the pieces are aligned before casting.

 

There are also other classifications of fractures and they include:

  • Single fracture – Here, the bone is broken only in one place.
  • Hairline fracture – This is an incomplete fracture; there is a thin crack which does not go all the way through the bone.
  • Segmental fracture – The break is in two or more places on the same bone.
  • Comminuted fracture – Here, the bone is broken in more than two places or crushed in pieces.
  • Corner or bucket-handle fracture – This type of fracture is an injury of the metaphysis which is a piece of cartilage in children. The bone is not yet fully ossified. It is commonly seen in child abuse.

 

What are the Symptoms of Fractures in Children?

Some of the common symptoms of fractures include:

  1. Pain in the fractured area
  2. Bruising or redness in the fractured area
  3. Swelling in the fractured area
  4. Obvious deformity in the fractured area
  5. Difficulty using the fractured area

 

How Fractures in Children are Diagnosed

Any child who has had a fracture should be taken immediately to see a doctor. A series of investigations would be done and some include:

  • Taking a history of the events that happened which resulted in the fracture and other relevant questions.
  • Performing physical examination
  • X-rays
  • MRI (Magnetic Resonance Imaging)
  • CT scan (Computed Tomography)

 

Management

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Depending on the type and extent of injury, various treatment methods are performed:

1. Splint or cast

This is to immobilize the fractured area and to promote the alignment and healing. It also protects the fractured area from use.

 

2. Traction

The application of a force to stretch certain parts of the body in a specific direction. It includes the use of pulleys, strings, weights and a metal frame attached over or on the bed. Traction serves to stretch the muscles and tendons around the broken bone to allow the bone ends to align and heal.

 

3. Surgery

In some types of fractures, surgery is needed to put broken bones back into place. There are two methods known as internal fixation and external fixation using metal rods or pins to hold the bone fragments in place to allow alignment and healing.

 

4. Medications

Medications such as analgesics or anti-inflammatory drugs may be given for pain and inflammation. Antibiotics may also be given in the case where there is an infection or increased risk of infection.

 

How to Prevent Fractures in Children

Children should be carefully watched and advised to play carefully to avoid getting their bones broken. Although, this may be quite difficult because of their high activity levels.

Some children will tend to hide their injuries from their parents for fear of being scolded. It is important for parents to pay close attention to any of the signs or symptoms of fracture in their children and report to the hospital in good time for appropriate measures to be taken. This is to prevent complications like the broken bones joining back wrongly.

 

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