Childhood is a time of exploration, movement, and-inevitably-tumbles and falls. As parents, we do everything we can to keep our children safe, but sometimes accidents are unavoidable. When they do, one of the scariest outcomes can be a paediatric fracture-a break or crack in a child’s bone. Unlike adults, children’s bones are still growing, which adds both complexity and hope to the healing process.

This guide is designed to help parents understand the essentials of paediatric fractures, including the most common types of fractures in children, how to recognise them, and how they are treated. With the right knowledge and support, you can help your child recover quickly and grow stronger than ever.

What Are Paediatric Fractures?

Paediatric fractures refer to any break in a child’s bone. Because children’s bones are still developing, they are more flexible and have a thick, protective layer known as the periosteum. This makes children more resilient to fractures compared to adults, but it also means that when a fracture does occur, it may affect growth plates-areas of cartilage that allow bones to grow.

Understanding paediatric fractures requires not just recognising the break itself but also knowing how a child’s growth and bone structure impact healing and treatment options.

Why Do Children Break Bones So Often?

Children are naturally active, curious, and sometimes reckless. Whether it’s playing sports, climbing furniture, or simply running around the house, they’re prone to accidents. Common causes of paediatric fractures include:

• Falls from heights
• Bike or scooter accidents
• Sports injuries
• Trampoline injuries
• Playground mishaps
• Motor vehicle collisions

Because children are still growing, their bones have unique vulnerabilities, particularly in the growth plates, which are more susceptible to injury than fully matured bones.

Signs and Symptoms of a Fracture in a Child

So how do you understand whether it is a fracture or just a sprain? While some symptoms of fracture in children are obvious, others can be subtle. Some common signs are:

• Sudden swelling or bruising
• Pain, especially when touching or moving the limb
• Refusal to move the limb
• Deformity or misalignment
• Inability to bear weight (for leg fractures)
• Numbness or tingling

Identifying a fracture, as a common person, can be difficult. It is better to take your child to the paediatrician if things don’t look good or the pain won’t go away.

Common Types of Fracture in Child

Paediatric fractures can be of various types, each with different causes, symptoms, and treatment protocols. Let’s take a look at them:

Greenstick Fracture

Greenstick fractures are common in children, where the bone bends and cracks on one side like a green twig. Kids are more susceptible to such fractures due to their flexible bones. Symptoms include pain, swelling, and difficulty using the limb.

Torus (Buckle) Fracture

A torus fracture, also known as a buckle fracture, occurs when one side of a bone compresses, causing a buckle without a complete break. This type of fracture is commonly found in the forearm.

Complete Fracture

In this case, the bone breaks completely into two or more pieces. Types of complete fracture include:

• Transverse: Straight across the bone.
• Oblique: Diagonal break.
• Spiral: Twisting force causes a corkscrew-shaped break.

Growth Plate Fracture (Physeal Fracture)

These occur at the growth plates near the ends of long bones. Since growth plates control bone development, injuries here need prompt attention. Improper treatment can have a significant impact on the growth of bones in the future.

Open (Compound) Fracture

An open fracture occurs when a broken bone protrudes through the skin, a rare yet serious injury, particularly in children. Immediate medical attention is necessary to prevent infection and ensure proper healing.

Hairline (Stress) Fracture

These small cracks in the bone, often caused by overuse or repetitive activity, are known as stress fractures. They are particularly prevalent among adolescent athletes.

Displaced and Non-displaced Fracture

Fractures can be classified as displaced or non-displaced. In a displaced fracture, the bone breaks into two or more parts and shifts out of alignment. On the other hand, in a non-displaced fracture, the bone cracks but remains in proper alignment. Understanding the difference between these two types of fractures is necessary for determining the appropriate treatment and ensuring proper healing.

Causes and Risk Factors

Paediatric fractures are common in children because they are more active, their bodies are growing, and their bones are weaker than in adults. Understanding the causes and risk factors is key for prevention and treatment.

Common Causes of Paediatric Fractures:

• Accidental Trauma: Children most commonly suffer fractures from falls, motor vehicle accidents, sports injuries, biking/skateboarding/rollerblading, and playground injuries.
• Increased Bone Fragility: Certain conditions such as Osteogenesis Imperfecta, vitamin D deficiency (Rickets), and juvenile osteoporosis result in weakened bones that are more prone to fractures, even with minimal trauma.
• Childhood Diseases or Conditions: Children with cerebral palsy, muscular dystrophy, and metabolic bone diseases have weakened muscles or bones making them more likely to suffer falls and fractures.
• Non-Accidental Trauma (Child Abuse): Physical abuse or non-accidental injuries can result in fractures. These injuries are often suspicious and require a careful medical evaluation to differentiate them from accidental fractures.
• Overuse Injuries: Overuse or repetitive motion in children involved in activities like running, gymnastics, or ballet can lead to stress fractures, especially if the child is training intensively without proper rest.

Risk Factors for Paediatric Fractures:

Certain risk factors also increase the chances of a child getting a fracture. These include:

• Age: Younger children, especially toddlers (ages 1–4), are at a higher risk of falls due to their developmental stage. However, fractures can happen at any age.
• Gender: Males tend to experience fractures more frequently than females due to more physical activity, such as sports and rough play.
• Previous Fractures: Children who have had one fracture are at increased risk of further fractures. This can be due to repeated accidents or underlying health conditions that make bones weaker.
• High-Impact Activities: Children who participate in contact sports or extreme physical activities have a higher risk of fractures due to the physical nature of these sports (e.g., football, gymnastics, basketball).
• Environmental Factors: Children are at higher risk of injury and fractures when playing in unsafe areas without adequate supervision. Winter conditions increase the risk of falls, particularly for active children.
• Family History: A family history of osteoporosis or bone diseases, such as osteogenesis imperfecta, can predispose children to fractures.
• Nutritional Deficiencies: Inadequate intake of calcium and vitamin D can affect bone strength, increasing the risk of fractures. Malnourishment and poor diets can contribute to weaker bones.
• Medical Conditions: Children with chronic illnesses such as epilepsy, and diabetes, or those on long-term corticosteroids may have weakened bones, increasing fracture risk.

Diagnosis – How Doctors Confirm Paediatric Fractures

Diagnosing paediatric fractures involves a combination of a physical examination, medical history, and imaging tests. Here’s how doctors typically confirm paediatric fractures:

• Medical History: The doctor will ask about the child’s symptoms, injury history, and any pre-existing conditions that may affect bone health and fracture risk.
• Physical Examination: The doctor’s assessment will involve checking for physical signs of injury like swelling, bruises, and cuts. They will press gently to check for tenderness and test the range of motion for signs of a fracture. If there is a break in the skin, they will check for an open fracture.
• Imaging Tests: Imaging, such as X-rays, ultrasound, CT scans, and MRIs, is essential for confirming a fracture diagnosis. X-rays are commonly used to show bone alignment and severity of the fracture, while ultrasound can detect soft tissue injuries. CT scans are recommended for complex fractures in difficult-to-see locations, and MRIs are used for soft tissue involvement and detecting stress fractures.
• Bone Scintigraphy (Bone Scan): A bone scan, using radioactive material, can help detect stress fractures that aren’t visible on X-rays. It is also useful for identifying multiple fractures, especially in cases of child abuse or conditions like osteogenesis imperfecta.
• Assessing Neurovascular Status: After a fracture, doctors check for signs of nerve damage such as loss of sensation or paralysis in the limb. They also check the pulse and blood flow to ensure no damage to vessels, which could cause complications like compartment syndrome.
• Laboratory Tests (Rarely): Doctors order tests to check for infection, inflammation, and bone health in cases of open fractures or surgeries. This includes checking for vitamin D levels, calcium levels, and metabolic bone diseases for underlying bone disease or recurrent fractures.

Treatment Options for Paediatric Fractures

Treatment for paediatric fractures focuses on promoting healing, reducing pain, preventing complications, and restoring normal function.

Conservative (Non-Surgical) Treatment

For simple fractures or less complicated injuries, non-surgical methods like casting, splints, braces, traction, and pain management are usually enough for healing. Casts immobilise fractures for 4-6 weeks, splints provide support for fingers, toes, or wrists, traction aligns bones before casting, and pain management includes NSAIDs, elevation, ice packs, and rest.

Surgical Treatment

Surgery may be needed for complex fractures or to prevent growth plate damage. Closed reduction aligns bones without surgery, while open reduction and internal fixation use surgery and metal plates. External fixation stabilises fractures with pins and screws connected to an external frame for proper healing.

Rehabilitation and Physical Therapy

Rehabilitation after a fracture involves physical therapy to regain strength and mobility, with techniques such as stretching and strengthening exercises. The duration of this phase varies depending on the severity of the fracture. A gradual return to activity is important to help the child regain confidence and mobility in the injured limb while avoiding further injury.

Follow-Up Care

Regular follow-up visits and X-rays are important to monitor the proper healing of the bone after an injury. Parents and caregivers should watch for signs of complications like increased pain, swelling, or changes in the shape of the injured area.

Complications You Should Watch For

Sometimes paediatric fractures can lead to complications. So parents, caregivers, and healthcare providers need to stay vigilant and address any issues early during the healing process.

• Improper Bone Healing: Malunion occurs when a bone heals in the wrong position, while nonunion happens when a bone fails to heal.
• Growth Plate Damage: This can affect future bone growth, leading to limb length differences or deformities.
• Infection: Especially after open fractures or surgery. Look for redness, fever, pus, or swelling.
• Nerve or Blood Vessel Injury: Signs include numbness, tingling, or a cold/pale limb.
• Joint Stiffness or Loss of Mobility: Especially if the fracture is near a joint or not followed by proper rehab.
• Re-fracture: The same bone may break again if full strength hasn’t returned.

Preventing Paediatric Fractures

Preventing paediatric fractures involves safety measures, nutrition, physical activity, and parental awareness. With the right strategies in place, many fractures can be avoided in active children. Here are some precautions that you can take:

• Encouraging safe play: Supervision during activities and ensuring safe play environments can reduce the risk of falls and injuries.
• Promoting bone health: A balanced diet rich in calcium and vitamin D, along with regular physical activity, can help strengthen bones and reduce the risk of fractures.
• Using protective gear: Wearing helmets, knee pads, and elbow pads during sports and recreational activities can reduce the risk of injuries.
• Regular health check-ups: Ensuring timely medical assessments for children with conditions like osteogenesis imperfecta, rickets, or other risk factors can help manage and mitigate fracture risks.

Sources:

• https://www.hopkinsmedicine.org/health/conditions-and-diseases/fractures-in-children
• https://www.childrensnational.org/get-care/health-library/broken-bones
• https://www.stanfordchildrens.org/en/topic/default?id=fractures-in-children
• https://www.childrens.com/health-wellness/fractures-and-broken-bones
• https://www.pedistat.com/blog/what-parents-should-know-about-pediatric-fractures
• https://www.childrens.com/specialties-services/conditions/fractures
• https://www.huntingtonorthopedics.com/tips-for-preventing-pediatric-fractures/