About fractures

What is a fracture?

A fracture (broken bone) is a disruption, partial or complete, in the bone. There are many different types of fractures including:

Initial classification includes:

  • Open fracture (also called compound fracture) - the bone exits and is visible through the skin, or a deep wound that exposes the bone through the skin.
  • Closed fracture (also called simple fracture) - the bone is broken, but the skin is intact.

Fractures have a variety of names. Below is a listing of the common types that may occur in children:

  • Greenstick - incomplete fracture. The broken bone is not completely separated.
  • Transverse - the break is in a straight line across the bone.
  • Spiral - the break spirals around the bone; common in a twisting injury.
  • Oblique - diagonal break across the bone.
  • Compression - the bone is crushed, causing the broken bone to be wider or flatter in appearance.
  • Comminuted - the break is in three or more pieces.

What causes a fracture?

Fractures occur when there is more force applied to the bone than the bone can absorb.

Breaks in bones can occur from falls, trauma, or as a result of a direct blow or kick to the body.

A child's bone differs from adult bone in a variety of ways:

  • A child's bone heals much faster than an adult's bone. The younger the child, the faster the healing occurs.
  • Bones are softer in children and tend to buckle or bend rather than completely break.
  • Children have open growth plates, also called physis, located at the end of the long bones. This is an area where the bone grows. Injury to the growth plate can lead to limb length discrepancies or angular deformities. Often requires longer follow up by pediatric orthopedic provider, pending location and severity of injury. Growth plate injuries are classified into the following:

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What are the symptoms of a fracture?

The following are the most common symptoms of a fracture. However, each child may experience symptoms differently. Symptoms may include:

  • Pain in the injured area.
  • Swelling in the injured area.
  • Obvious deformity in the injured area.
  • Difficulty using or moving the injured area in a normal manner.
  • Warmth, bruising, or redness in the injured area.

The symptoms of a broken bone may resemble other conditions. Always consult your child's physician for a diagnosis.

How is a fracture diagnosed?

The physician makes the diagnosis with physical examination and diagnostic tests. During the examination the physician obtains a complete medical history of the child and asks how the injury occurred.

Diagnostic procedures may include:

  • X-rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  • Magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body. This test is done to rule out any associated abnormalities of the spinal cord and nerves.
  • Computed tomography scan (Also called a CT or CAT scan.) - a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called "slices"), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.

Treatment for a fracture:

Specific treatment for a fracture will be determined by your child's physician based on:

  • Your child's age, overall health, and medical history.
  • Extent of the fracture.
  • Your child's tolerance for specific medications, procedures, or therapies.
  • Expectations for the course of the fracture.

The goal of treatment is to control the pain, promote healing, prevent complications, and restore normal use of the fractured area.
An open fracture (one in which the bone exits and is visible through the skin, or where a deep wound exposes the bone through the skin) is considered an emergency. Seek immediate medical attention for this type of fracture by calling 911.

Treatment may include:

  • Splint/cast - immobilizes the injured area to promote bone alignment and healing to protect the injured area from motion or use. Many different types of splinting and casting material is used based on fracture and location. Casts typically consist of either:
    • Fiberglass – which is light weight. Available in many different colors. Cannot get wet.
    • Plaster casts – may be used initially, as a splint. Also used with clubfoot casting.
    • Orthoglass – often used on a temporary basis, as a splint.
    • Waterproof casts – allows the cast to get wet. Not suitable for all fracture types. Check with provider if ok to swim.
  • Medication– either over the counter or prescription
  • Reduction – typically performed in emergency department with additional medication and close monitoring. May need to be done in operating room, while the child is under general anesthesia.
  • Manipulation – can be completed in clinic setting if fracture is not in ideal position. This is an alteration of fracture position typically through molding of cast.
  • Surgery – occurs in operating room. Child is under general anesthesia. May include reduction or may require hardware fixation with use of metal rods, pins or plates to maintain proper alignment of fracture. Hardware may stay in permanently or be removed at a later time, either in the clinic or in surgery.

Cast removal

Watch how easy and painless it is to have a cast removed.