Pediatric Fractures - Treatment and Surgery

A pediatric fracture occurs when a child’s bone is completely or partially broken due to applied force. Pediatric bone fractures are different than adult fractures and should be treated by doctors who specialize in the diagnosis and treatment of pediatric bone conditions to ensure these differences are appropriately considered.

Types of Pediatric Fractures

Aside from open (when the bone breaks the skin) and closed (when there is no open skin), there are multiple types of fractures affecting children, including:

  • comminuted fractures, in which the bone has broken into multiple pieces
  • buckle/torus fracture, in which the fracture only reaches one side of the bone, which buckles or bends onto itself while the other side remains intact
  • stress/hairline fracture, in which the bone cracks but does not separate or break completely
  • greenstick fracture, in which one side of the bone breaks causing the other side to bend inward
  • growth plate fractures, in which the portion of the bone responsible for bone growth is broken, causing added risk of complications such as stunted growth
  • displaced fractures, in which the bone breaks and the broken ends separate or disalign
  • non-displaced, in which the bone breaks but the ends remain in line with each other

Fractures in children vary significantly from fractures in adults. Because the bones are flexible in children, greenstick and torus fractures are common in children but not typically seen in adults. Another unique consideration in pediatric fractures is the vulnerability of their growth plates; special consideration must be taken for children whose growth plates have been affected by the fracture to prevent long-term complications or deformitites from occurring.

Causes and Risk Factors

The most common causes of fractures in children include trauma and falls, especially resulting from playground falls and sports injuries. Boys are at higher risk of breaking a bone than girls are. Obesity, poor nutrition, and a history of fractures also increase a child’s risk of breaking a bone. Kids who are very active and participate in sports and other physically demanding activities are also at increased risk.

Signs and Symptoms of a Fracture

Each child and unique situation is different. Some children may go days with a fracture before it becomes evident to parent while others are brought to the emergency room immediately due to pain. Immediate indications of a fracture include an obvious deformity, severe pain, swelling, warmth, or bruising in the area of injury. If your child is not in serious pain and no fracture is visually obvious, keeping an eye on your child’s mobility and function can help you identify a fracture.

Treatment of Pediatric Fractures

If you suspect your child has a fractured bone, medical attention should be sought immediately. The best place to seek treatment for a broken bone is the emergency room; you will be referred to the right specialist from there if necessary. In the meantime (en route to the emergency room), you can help by keeping the injured limb still and icing the injury.

In most cases, an x-ray examination with several views is taken to see the bone and evaluate the fracture. Once the x-ray is read, doctors can determine whether the fracture will require surgery or not.

Non-displaced fractures are often treated using immobilization. While the injury is new, the bone is typically splinted to allow room for swelling before a cast is placed. Once the swelling has reduced, a cast can be placed to prevent movement and strain and allow the fracture to heal completely. Pain medication may be prescribed to manage pain.

Displaced and comminuted fractures often require surgical treatment to realign the bones before immobilization. Metal pins, rods, or screws are used to position the bones and hold them in place long enough for healing to occur. In some cases, bones can be realigned without surgery using techniques like closed reduction or traction.

The Process

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