A fracture is a break in bone.
This is one of the most common accidental injuries in children. In this article, our ATP Consultant Orthopaedic surgeon, Dr Agboola Taiwo discusses what you need to know about fractures as parents.
Our bones provide structural support for us and assist with movement. Fractures result when energy is applied to our bodies which overcome the strength of bone and results in breakage. Fractures result when energy is applied to our bodies which overcome the strength of bone and results in breakage. It is however important to remember the energy applied which is strong enough to break bones can damage other important structures like organs they protect, blood vessels and nerves.
What are the causes of fractures?
Commonly result from accidents which may be at home, school, playgrounds etc. These may be from falls, heavy object impact, sports injuries etc. These may be from falls, heavy object impact, sports injuries etc. Motor vehicle accidents can also cause injuries and in these if a lot of energy is involved can result in severe injuries. Another cause is non accidental injury when persons intentionally inflict trauma on children in instances of child abuse.
How can we recognise fractures?
Listen to the child’s story. The child may tell of a fall, previously playing and now in pain holding affected limb or area. There may be anguished cries, limp or unwillingness to use a limb. Swelling and deformities are also common. In very little children you may not get a story as they cannot speak but the above symptoms are evident.
The main test to diagnose fractures are x rays.
What other things may appear like fractures?
- Soft tissue injuries: these are injuries with no bone break but appear with swelling and pain. Usually self limiting and will resolve in time.
- Bone infections: these also appear with swelling and pain but may result in fever and eventually pus discharge.
How do we manage fractures?
First aid includes:
- Removal from danger area in a safe way, In severe motor vehicle accidents extrication is better done by trained professionals.
- Splint of affected limb – this help to reduce painful movements can be made from simple household items.
- After first aid, it is advisable to seek medical treatment usually provided by orthopaedic surgeons or emergency doctors.
Professional treatments are divide into:
- Conservative or non operative treatment methods.
- Non-conservative or operative methods – this is where the orthopaedic surgeons operate to fix the fractures
Conservative methods include the use of simple things like splints or slings for simple cracks that only require support of the bone as the bone rapidly heals with time. In other instances however the bone ends may be deformed or the bone ends are not even in contact. In those cases attempt may be made to straighten out the bone under analgesics or anaesthesia and a support applied. These supports range from plaster of Paris casts (POP). Sometimes application of weights to pull the bone straight while the person lies in bed can also be done.
In some instances however if one cannot get the bone in alignment by simple manipulation and pulling; there may be need for operations to open to the bone and if the risk of the bone losing contact is high we may also use some metallic implants to hold the bone in place till the fracture heals. This type of treatment is to be done or supervised only by trained orthopaedic surgeons. The next thing however after the treatment is applied is to give time for healing.
How long do fractures in children take to heal?
Of course this depends on the age of the child, the younger the faster. It also depends on the bone involved lower limbs (legs) take approximately twice as long as upper limb (arms) fractures. Generally lower limb fractures in children may take from 2 to six weeks to heal and in upper limbs about 2 to 4 weeks.
Complications of fractures in children
- Injury to adjoining structures like nerves blood vessels.
- Infection especially in fractures involving open wounds.
- Failure of union of the fracture (not common in children). What is more common is when the fractured ends heals in an abnormal position resulting in permanent deformities like shortening curvature etc.
- Injury to areas in the bone where growth occurs called the physis which then results in shortening of the affected limb.
- Compartment syndrome which may result from poor treatment when tight materials are applied to fracture bones and when subsequent swelling then occurs in the tight material results in loss of blood supply to the limb and the limb may actually die off. This has happened when traditional bone setters or poorly trained physicians apply tight POP casts.
After treatment is done splints or casts are removed and we get the limb moving as safely and as soon as is possible. We ensure this by checking for healing on x-rays.
Cold compresses can help reduce swelling, modulate or reduce pain. However use of water that may burn is not advisable. Its also important to note that it may be more useful to splint the limb to provide these same soothing effects.
I generally would not recommend use of traditional bone setters. It stands to reason that you would want your child treated by the most knowledgeable person available with the best materials and methods available.
Most fractures will heal whether we treat them or not, the important thing is for one to be able to recognise the complicated ones from the beginning and manage appropriately.