Fractures are the most common and potentially serious childhood injuries and they are the number one reason for a referral to an orthopaedic surgeon.
Approximately half of all children will eventually suffer from a fracture or other serious orthopaedic injury. Most common childhood fractures are the result of “low-energy trauma,” including playground falls and sports-related injuries and “high-energy trauma,” such as motor vehicle accidents.
Fractures are more often seen in boys than in girls and tend to increase with age, peaking at about age 13. Most childhood fractures occur in the upper extremities, including the forearm, hand and elbow. Less often, but equally important, are fractures to the leg and ankle.
Fractures to the hip are more rare but among the most serious because of the potential for permanent damage leading to degenerative arthritis.
The presence of pain, swelling, bruising and deformity can suggest a bone fracture. X-ray’s are generally required to determine the type of the fracture.
Occasionally, the fractured bone can tear through the skin, leaving a bleeding wound. If this is the case, the bone has been exposed to contaminant particles that greatly increase the risk of infection. Medical attention should be sought as soon as possible because surgery is required to clean the bone and surrounding tissue. The risk of infection increases if cleaning the bone is delayed more than six hours after the injury.
Two very common types of fractures in children are usually seen in the forearm and the elbow. Two bones create the forearm: the radius and the ulna. If you hold your forearm with the hand facing forward, the radius is on the thumb side of the forearm and the ulna is on the opposite, or little finger side of the forearm. About half of all pediatric fractures affect the forearm. They are usually the result of a fall onto an outstretched arm. Skateboards, scooters or rollerblades are usually the culprits of this type of break.
In young children, most types of forearm fractures can be treated without surgery by manipulating the bones into position and casting. Older children, those with severely displaced or unstable fractures, and those in which the fractures are associated with a dislocation of the joints, either at the wrist or at the elbow, will likely require surgery.
Fractures of the lower part of the humerus (upper arm bone) account for about 60 percent of all elbow fractures in children, also the result of a fall onto an outstretched arm.
Playground equipment, especially monkey bars, are mostly commonly associated with these injuries. If the lower part of the humerus is broken, kids will complain of elbow pain and will refuse to move it. The severity of the break will be determined by the amount of displacement between the bone fragments. Fractures with minimal displacement, which are the most common type, will carry smaller risks and can be treated with manipulation and casting. However, severe fractures can result in nerve and blood vessel damage and permanent deformity. Immediate attention by an orthopaedic surgeon is recommended to determine the need for surgery. For severe fractures, manipulation under general anesthesia is usually required, followed by fixation with metal pins.
Adult supervision when playing, safe playground equipment with resilient ground surfaces, and the use of appropriate protective gear are key factors in preventing children’s fractures.
Dr. Mauricio Silva is an assistant professor of UCLA and Orthopaedic Hospital Department of Orthopaedic Surgery, www.orthohospital.org.