Story by: Laura K. Jacks, M.D. on July 26, 2018
It’s the season where kids are outside playing and, unfortunately, experiencing injuries such as a fracture, better known as a broken bone. Laura K. Jacks, M.D., pediatric orthopedic surgeon with Norton Children’s Orthopedics of Louisville, answers common questions parents have when a child experiences a broken bone.
Broken bones, also known as fractures, in children are most commonly caused by a fall, sporting event or traumatic event such as a car accident.
There are many different ways to describe a broken bone: buckle, torus, greenstick, transverse, oblique, spiral, growth plate and physeal. All of these words are descriptions about how and where the bone is fractured. Most fractures require similar treatment with immobilization in either a splint, cast or brace.
Bones heal slowly over time. In children, this process takes 3 to 12 weeks depending on the location, type of fracture and age of the child. A callus, or bone scar, forms over the broken area and will harden and increase in strength during the recovery phase. The bone then takes many months to regain normal strength. This healing occurs best if there is immobilization and limited weight put on the fractured area.
X-rays usually are taken to see if there is a broken bone. In children, because their bones are still forming, there may not be a fracture visible on the X-ray, but by exam the orthopedic doctor can recognize a fracture.
Norton Children’s is Louisville’s leader in orthopedic care. Our pediatric orthopedic specialists understand that growing children have their own unique needs, as do their bones and muscles.
The emergency department might place your child in a splint to allow for swelling. In a cast, if the extremity starts to swell there may not be enough room to allow for this expansion. By placing a splint, the extremity can swell and not be enclosed in a cast.
There may be some swelling at the site of the fracture. Elevating the fracture above the level of the heart on pillows can help reduce swelling. Ice also can be applied to help with pain and swelling.
Rest, ice, elevation and swelling management all are helpful in reducing pain. When your child moves or tries to use the injured extremity, they may have more pain. Most pain can be controlled with Tylenol (acetaminophen) or Motrin (ibuprofen). If you went to an ED, depending on the severity and/or location of the fracture, your child may be prescribed some narcotics to help ease the pain.
The splint was put on the affected extremity to protect it. Most likely there is no new fracture or injury to the injured site. If you are concerned, you can take the child back to the emergency room. Otherwise, waiting for your scheduled appointment should be OK. The splint will continue to keep the extremity immobilized.
Your child would not be sent home if you needed surgery immediately. Most of the time, surgery would occur in the next few weeks, not immediately, to see if conservative measures will allow the bone to heal. If conservative measures, such as casting, fail, then surgery would be an option that would be explored with the family. Additionally, surgery often is easier if swelling has gone down after the initial injury.
A fracture in the growth plate is going to have the same treatment as a fracture in the bone. A fracture in the growth plate requires immobilization with a splint, cast or brace. Only a few injuries to the growth plate cause long-term issues, and this would be discussed at your appointment if there were a concern.
Please follow up in the orthopedic office to evaluate for a fracture. Children’s bones are partially made up of cartilage, and their bones have not hardened. Cartilage cannot be seen on an X-ray, so a focused exam done by an orthopedic doctor may indicate an injury to the cartilage. If this is the case, it would be treated the same as a fracture.
You should still come in for follow-up. Many children may appear to be fine and may not have any pain with limited activity. However, after physical exam there will still be tenderness on the bone and they still need to be immobilized to allow the fracture site to heal properly. It’s better to be safe than sorry and have the bones checked out by an orthopedic doctor who specializes in this area.
Wherever you were treated initially should be able to supply you with a splint or brace if there is an injury.