Childhood bone fractures are common and often cause concern for patients, parents, and clinicians. It is a condition in which a bone of a child (younger than the age of 18) is cracked or broken. About 15 per cent of all injuries in children are fracture injuries. The most common cause of fractures in children is a fall or some other sort of trauma. Though rarely, the bones may also break due to weakening because of some underlying disease like infection, tumour, congenital weakness, etc. The probability of bone fractures in children increases with age. When age increases, so does mass and speed, resulting in more serious fractures. The age when girls usually fracture a bone is 12, and for boys the age is 14. About half of boys and one-fourth of girls are likely to have a fracture during childhood.
Fractures in children are different from those in adults due to differences in their bone structures. These differences are important for correct evaluation and treatment of fractures. A child’s bones heal faster than an adult’s because a thicker, stronger, and more active dense fibrous membrane (periosteum) covers the surface of their bones. The periosteum has blood vessels that supply oxygen and nutrition to bone cells. Stronger and thicker periosteum in children causes better supply of oxygen and nutrients to bones, and this helps in remodelling of fractured bones faster. A child’s fractures not only heal more quickly, but also are significantly reduced due to the thickness and strength of the periosteum.
Anatomy of a child’s bone
Another difference in a child’s bone is the presence of growth plates, from where the bones grow. In children, the growth plates are open, which helps to manage a child’s fractures. A child’s growth also helps in remodelling of bones, so bone deformities are corrected. The open growth plates in a child’s bones help significantly to reduce deformity, but an injured growth plate can also lead to length discrepancies or abnormal bone growth.
Types of fractures
The bones of a child are more likely to bend than to break completely because they are softer and the periosteum is stronger and thicker. The fractures that are most common in children are the incomplete fractures; these fractures are the greenstick and torus or buckle fractures. Greenstick fracture involves a bend on one side of the bone and a partial fracture on the other side (like breaking a green stick), whilst a torus or buckle fracture occurs at the metaphyseal locations and resemble the torus or base of a pillar in architectural terms. Acute angulation of the cortex is noted, as opposed to the usual curved surface. An incomplete (hairline) fracture is also common in children, where a thin crack in the bone doesn’t go all the way through the bone.
Symptoms of a bone fracture
Even though symptoms vary widely after experiencing a bone fracture, the most common fracture symptoms include:
- Pain in the fractured area
- Swelling in the fractured area
- Obvious deformity in the fractured area
- Not being able to use or move the fractured area in a normal manner
- Bruising, warmth, or redness in the fractured area
Bone fractures are sometimes part of physical abuse of children. These fractures may be serious and if not dealt with correctly, have the potential to lead to death of the child. Fracture patterns in abuse fractures that are very common are fractures in the growing part of a long bone (between the shaft and the separated part of the bone). Multiple fractures of varying age, bilateral fractures, and complex skull fractures are also linked to abuse.
Whenever a fracture is suspected in a child a doctor should be contacted immediately. To decrease the pain, bleeding and movement, a splint is used to immobilise the fractured area. Treatment for a fracture follows a simple rule: the bones have to be aligned correctly and prevented from moving out of place until the bones are healed. The most common form of treatment in children is case immobilisation of the fractured bone, as most fractures heal successfully after having been repositioned, using a simple plaster or fiberglass cast.
Sometimes, traction is required as a part of treatment to align a bone by a gentle, steady pulling action. The pulling may be transmitted to the bone or bones by a metal pin through a bone or by skin tapes.
Open reduction and internal fixation
This treatment is used only when an orthopaedic surgeon assigns it to restore the fractured bone to its original function. This method positions the bones to their exact location, but there is a risk of infection and other complications. The procedure involves the orthopaedist performing surgery on the bone to align the bone fragments, followed by the placement of special screws or metal plates to the outer surface of the bone. The fragments can also be held together by running metal rods through the marrow, in the centre of the bone.
In summary, childhood fractures are a very common occurrence and most of the children sustain one or more of such fractures in their growing years, due to falls whilst playing. Majority of the fractures are simple to treat and heal quickly, but some of the fractures may be serious, especially if they involve the growing end of the bone, and hence must be treated in time with great accuracy by a specialist.