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Broken Bones and Fractures

Orthopedic Guide to Broken Bones and Fractures

Common Breaks, When to Seek Care, and More

What are some common bone breaks and fractures – and when should we go to the ER? Here’s important insight from a VCU doc.

Your child just took a nasty spill, and now you’re wondering if they have a broken bone or just a bruise that’ll fade in a few days. It’s not always easy to tell, but there are some clues that medical attention might be required.

When to seek care for a broken bone or fracture

Broken bones are most common in the upper and lower extremities. A snap or grinding sound at the time of injury often indicates a fracture, but not always. If your child has an extremity injury, there are a few ways to determine if they need to be seen immediately or if it can wait until later. 

Kids should be seen as soon as possible if:

• The extremity has a deformity. This might look like a bump or change in shape around the bone.

• There’s a break in the skin and bone is showing.

• They can’t bear weight on or use the extremity fifteen minutes after the injury occurred.

• You’ve tried rest, elevation, ice, and over-the-counter pain medication, and there is crying and pain is not controlled.

If any of these things are true, seek medical attention at the emergency room immediately and don’t allow the child to eat in case surgery or a procedure to align the bone is needed. If there is severe bleeding, a break in the skin, or possibility of a spinal injury, call 9-1-1.

If the extremity appears deformed, clothing should be carefully removed or cut from the injured limb and the limb should be supported with a makeshift splint. This splint can be made with soft padding around the injury and something firm – like cardboard or folded newspapers – extending beyond the joint above and below the injury.

If your child is not experiencing any of the above and the extremity isn’t very swollen, they can potentially wait to see a physician in an outpatient clinic for an exam and x-rays if needed. Cold compresses or ice wrapped in cloth can help reduce swelling in the meantime, but don’t apply ice directly to the skin as this could cause frostbite.

What are the different types of fractures?

Open versus closed fractures: Bone fractures are classified as either open or closed. A closed fracture happens when the bone is broken, but the skin is still intact. An open fracture, also known as a compound fracture, is relatively rare in children and happens when the bone breaks through the skin.

Non-displaced fracture: Occurs where there’s a crack in the bone, but the bone hasn’t shifted out of place. Stress fractures (when tiny cracks form in the bone) or buckle fractures (when one side of the bone buckles on itself) are two common non-displaced fractures. Typically, these can be treated with a brace, splint, or cast to immobilize the extremity and allow the bone to heal.

Displaced fracture: This happens when a bone is broken and moves out of position. Displaced fractures can include: greenstick – one side of the bone is broken, causing the other to bend like a broken tree branch; rotated – the bone spun or rotated when it broke; angulated – the ends of the broken bone are angled toward each other; and translated – the bones have shifted out of alignment. Displaced fractures need to be realigned before casting.

Growth plate fracture: Growth plates refer to the softer pieces of developing cartilage tissue, which form the length and shape of the bone. Since growth plates are weaker than bone, they’re more prone to injury. Growth plate fractures can lead to issues with future growth and bone development and may require follow-up over time.

Common broken bones in children include:

• Ankle: This typically occurs from a twist or fall from an activity like skateboarding, running, roller-blading, or riding a scooter.

• Elbow: A common injury making up about 10 percent of fractures in kids, elbow fractures can happen in one or more of the three bones that make up the elbow.

• Forearm: Forearm fractures are the most common fractures in children, occurring anywhere on the radius and/or ulna, the two bones that make up the forearm.

• Femur: The femur is the largest bone in the body and connects to the pelvis to form the hip. Most frequently, femur fractures occur close to the knee through the growth plate.

• Tibia: The tibial shaft area refers to the shin bone and smaller fibula bone that make up the lower leg. Fractures of the tibia around the knee most frequently occur with jumping activities. Fractures in the middle of the bone (called the tibial shaft) occur frequently in toddlers with smaller falls or twists, but are the result of a larger amount of force in older kids. Fractures also occur frequently in kids in the growth plates at the end of the tibia and fibula as part of the ankle.

How long does it take a broken bone to heal?

Depending on the type of bone and severity of the break, it can take about six weeks or more until kids can return to normal activities. The type and location of the break dictate what strategy will be used to immobilize the affected bone – clinicians use casts, splints, braces, boots, and more. Bigger bones and older kids will typically take longer to heal.

Broken bones can be scary, but with proper care and treatment, they will heal, and in most cases, that means your child will soon return to normal activities. 

Disclosure: This article solely addresses extremity injuries and not multiple traumas including possible abdominal or head injuries. If those are suspected, seek medical attention immediately. Do not move the child if there is suspected neck or spine injury.

Victoria Kuester, MD is an orthopaedic surgeon at Children’s Hospital of Richmond at VCU. Dr. Kuester lives in the city, and enjoys church, the outdoors, and spending time with her husband and two boys.
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