Ask the Experts: How to tell if a child has a break or a sprain?

By Kristy Bleizeffer Feb 9, 2017

It’s every parent’s nightmare: A fall, sports collision or other calamity results in a painful injury to an arm, leg or other extremity.

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What’s a parent to do? Does it require a trip to the Emergency Room? If there is a fractured bone, what can doctors do about it? Here, orthopedic surgeon R. Lee Stowell, M.D., sheds light on an all-too-frequent rite of passage.

How common are bone fractures in children, and are they more prone than adults?

The exact incidence of pediatric fractures is unknown. However there are studies that suggest that around one third of children will sustain at least one fracture before the age of 17.  Furthermore, fractures are the presenting cause of approximately 9 percent of all pediatric injuries for which medical attention is sought.

Are they more common in summer as more kids are out and about outside?

The overall incidence of injuries does fluctuate with the time of year.  However, we more commonly see changes is the type of injury or mechanism of injury rather than a true significant change in the frequency.  As an example, snowboarding injuries can differ significantly from playground injuries.

How do you know if you child has suffered a fracture, or if they just pulled a joint or a tendon?

It can be very difficult to tell in some instances, especially if the child is too young to tell you what happened.  In many events, to know for sure, an X-ray may be necessary.  

In general terms, pain that is inconsolable, deformity, refusal to bear weight or use the extremity are indications that a significant injury may have happened and medial attention should be sought sooner rather than later.

How are pediatric fractures different than those found in adults and seniors?

Pediatric bone is more elastic  and thus leads to unique fracture patterns such as buckle fractures (when one side of the bone ‘buckles’ in on itself but doesn’t affect the other side) or greenstick fractures (when bone bends and then breaks, usually seen in infants and younger children).  

Additionally children have a thicker covering to the bone known as periosteum  which generally remains intact and helps with reduction and potentially limit some of the displacement of the fracture fragments.  Children also have a greater potential for remodeling of the bone by virtue of open growth plates.

What are growth plate fractures?

Growth plate fractures are a special subset of fractures in which the fracture line extends through or into the actual growth plate of the bone.  The advantage of having open growth plates is that they allow for remodeling and straightening of a malunited fracture.  This often means that a badly displaced fracture may remodel and allow the bone to appear normal some years later.  However, these fractures are also associated with unique complications such as premature closure of the growth plate which may result in changes in length or angulation.

What is the most common fracture in children, and what are the common causes?

There are many ways in which fracture type and mechanism are grouped. In general terms, the most common injury comes from falls which produce fractures of the long bones such as the femur or tibia. Collisions and traffic injuries typically lead to hand and foot injuries.  Overall, the most common fracture site is the distal forearm with a peak incidence occurring at age 11 to 12 years in girls and 13 to 14 in boys.

Based on previous studies and looking purely at the absolute number of sport-related injuries, the number is highest in soccer followed by snowboarding, hockey and equestrian sports.  Interestingly, some of the sports associated with the fewest fractures include cross country skiing for boys and martial arts for girls.

Are most fractures treated the same way?

Fracture treatment is determined by each individual fracture, taking into account the location, displacement and the age of the patient, among other factors.  However, because of the tremendous remodeling potential of children, many fractures that would require surgery in adults can often be treated with casts or splints in children.  

Certainly there are fractures in children that require surgical stabilization including  the use of rods or plates and the smaller anatomy of children can pose special challenges.