Kids are always on the move, working hard and often playing harder. It’s not altogether surprising that one in five kids will break or fracture a bone during the course of their childhood. Forearm fractures from falls are the most common injury, though we see plenty of broken wrists, legs, and other bones, too.
When to Seek Medical Care
A child should be seen right away if:
- The injured extremity has a deformity
- Bone is showing through a break in the skin
- They can’t bear weight or use the extremity after 15 minutes
- Pain is unbearable
- There was a snap or grinding sound at the time of injury
Even if they’re not experiencing the above symptoms, it’s a good idea to be checked by a medical provider if pain, bruising, or swelling persist after a day.
They’ll get an X-ray to determine the exact type and location of the injury. If the fracture is displaced, it may require a reduction or manipulation. This means it needs to be placed back into or near its original position. For severe breaks, and in other cases depending on the child’s age, underlying health conditions, etc., sometimes surgery is needed to properly align the bone for healing.
Your child will likely get a temporary splint at first to allow swelling to subside. After a few days to a week, they’ll go back to get a cast. Occasionally other methods, such as a removable brace, are used depending on the stability of the fracture.
How Bones Heal
The healing process usually takes four to ten weeks and occurs in three stages.
1. Injury (1–2 days)
When a bone breaks, the body sends out signals for special cells to create inflammation and a blood clot around the break. The swelling and pain tell the body to stop using the injured body part.
2. Healing (soft callus 3–4 days, bony callus 4–8 weeks)
A callus, or type of soft bone, replaces the blood clot and holds the bone together. As the soft callus becomes harder, pain goes away, and the body part can be used again. In most cases, healing is sufficient enough to remove the cast after six to eight weeks. The fracture location may be very prominent due to the healing response with the callus or new bone formation. Your child’s arm or leg may look smaller than normal and have limited movement at first. They should regain strength and movement on their own through daily activity over the next four to six weeks. A brace and/or activity restrictions may be recommended during this time to avoid re-injury.
3. Remodeling (months-years)
Regular bone gradually replaces the hard callus. Initially, the healing bone will still look uneven on an X-ray. Over the next few months, the bone is reshaped and goes back to looking the way it did before injury.
How to Help During the Healing Process
Not much can be done to speed up the healing process, but you can help your child recover by making sure they:
- Eat a well-balanced diet that includes plenty of calcium and Vitamin D
- Avoid soda and sports or energy drinks
- Avoid smoking, vaping, and second-hand smoke, which can impair healing
- Follow the directions provided by their health care team and attend follow-up appointments
Casts can get uncomfortable, but unfortunately, there’s no way around that. Over-the-counter medications such as Benadryl, Motrin, or Tylenol can help with itching and pain. Blowing air into the cast with a hair dryer on the cool setting may also help. Don’t put objects inside the cast to scratch an itch. Keeping it clean and dry will prevent damage to the cast and itchiness or irritation to the skin.
Occasionally, skin sores develop beneath or along the edge of casts. Let your child’s doctor know if you think this is occurring so they can remove and replace the cast if needed.
The Significance of Growth Plates
Broken bones in kids aren’t the same as in adults. Kids’ bones have growth plates, which are soft cartilage at the end of the long bones (such as in the arms, legs, and fingers). They’re replaced by stronger bone as kids finish growing, usually around 14–15 years of age for girls and 16–17 for boys.
Growth plates are weaker and more susceptible to injury than the rest of the bone. Growth plate injuries can be difficult to see on an X-ray because the dark line of a fracture can look the same as the growth plate itself. They also begin to heal themselves quickly. Most growth plate injuries heal with no complications, but sometimes fractures in the growth plates can cause the bone to be crooked or too long or short later, so it’s important that injuries are addressed and growth plates are re-aligned quickly when injuries occur. For all these reasons, it’s ideal to have an evaluation with a pediatric specialist for any concerns of growth plate injuries.
The good news? Kids are resilient, and their broken bones usually heal well. The goal is to get them back on the playground or to their other favorite activities with a properly healed bone and a dose of extra caution to prevent another injury.
