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Childhood Fractures

16 Dec 2007 8:18 AM - Dr Roger Morris

Falls are the most common cause of injury in children presenting to an emergency department. Children with their relatively large heads, flexible bones and limited ability to protect themselves during a fall, frequently suffer from bone fractures and minor head injuries. Common fractures in children involve the clavicle (collar bone), humerus (upper arm bone), radius/ulna (forearm bones) and tibia/fibula (lower leg/ankle). Because children’s bones are more pliable than adult bone, an incomplete or ‘greenstick’ fracture may occur. This is where only one side of the fracture is broken and the other side is bent or buckled, like trying to snap a green stick.

A bone fracture should be suspected when a child presents with a deformity, swelling or localised tenderness of a limb after a fall. In very young children, not moving a limb or refusing to weight bear on a limb may indicate the presence of a fracture. Children who present with such symptoms after a fall or injury should be examined by a doctor to assess the need for an x-ray and further treatment. This examination also enables the doctor to rule out serious nerve and/or blood vessel injuries that can sometimes be associated with more severe fractures. Usually an x-ray is taken of the whole bone including the joint on either side of the area of injury. If present, fractures will be classified by their site (‘which bone’, ‘which part of the bone’), the appearance of the fracture line, whether the fracture is open or closed, and the degree of angulation and displacement of the fracture.

Initial first aid at the time of injury involves keeping the limb still or immobilised during transfer to medical help. The injured limb can be supported by a pillow, sling, magazine (curled into a U-shape around the arm and held with a bandage) or even sticks or branches (if in the bush). The limb should be elevated or raised higher than the heart to reduce the swelling and a cold pack can also be used. Fractured bones are often extremely painful and pain relief may be needed.

Once the injury has been properly assessed, definitive treatment will depend on the site, type, severity and deformity associated with the fracture. If a fracture is stable and not displaced or angulated, often no active treatment is required other than rest, elevation and pain relief. More deformed fractures may need to be manipulated and straightened (usually with some type of anaesthetic) before being immobilised in a cast. Severely angulated, displaced or unstable fractures sometime need to be treated with open reduction and fixation (ORIF) by a surgeon in theatre. These injuries are then immobilised in a cast. In children, small or minor fractures may heal within 2-4 weeks. Fractures of larger bones (for instance in the lower limb) may require up to 6-8 weeks to heal, depending on the severity of the initial injury.

A normal diet is all that is needed for a child’s bone to heal. Vitamin C and calcium are needed, but usually only in the amounts already found in a normal healthy diet. In most cases extra calcium or special diets are unnecessary. Because of the increased turnover and remoulding of bones in children, an appropriately treated fracture will be remodelled over time resulting in minimal, if any, noticeable deformity in the future.

Source: Young, S., Barnett P.L.J. & Oakley, E.A. 2005, ‘Fractures and minor head injuries’, MJA Vol 182 No.12, 20 June 1985, pp.644-648.