A bone fracture is a medical condition in which a bone is cracked or broken. If too much pressure is put on a bone than it can stand, it will split or break. If the broken bone pokes through the skin, it is called an open or compound fracture. In children incomplete fractures are frequent, in which the bones bend or buckle instead of break. The most commonly fractured bones are long bones (such as humerus, ulna, radius, femur, tibia and fibula). In some susceptible individuals, the spinal and pelvic bones can also get fractured, as a result of accident or falls.
Sometimes it is hard to tell a dislocated joint from a broken bone, but generally you can recognize a broken bone noticing these signs:
Fractures are very common in childhood, as children play games and sports, jump, ride bicycles, run down the stairs and so on. The harder they play, the harder they fall. But some children have an inherited condition called “osteogenesis imperfecta” that makes their bones more fragile and susceptible to breaking. Also, neuromuscular disorders, renal diseases, diabetes and growth hormone deficiency may raise the risk of fracture in children.
Your child may self-report pain, or you can observe it through her/his behaviour. For your child, it can be very painful to be touched or pressed on the injured limb. He/she can’t probably move it, and cannot bear any weight on it. Persistent crying is a common sign of pain in an infant, but it may also happen that your child doesn’t cry or respond. She/he may also faint or lose consciousness. Chest pain may indicate a broken rib. In all cases, try to reassure your child and keep her/him still and calm. If you suspect a fracture seek medical help immediately, or take your child to the nearest hospital emergency department if it’s possible.
In some very serious case, your child may have injured the head, the neck or the back: keep your child lying down until medical help arrives. In less serious injuries, you can apply on the injury a cold compress or an ice-pack wrapped in cloth. Do not apply ice directly on the skin. Leave the injured limb in the position you find it. It can be necessary for you to cut clothing off with scissors to prevent your child from having more unnecessary pain. Then you can place a soft padding around the injured part, and something firm (for example a board or rolled-up newspapers, etc.) next to the injured part, and long enough to go past the joints and below the injury. Fix it loosely with first-aid tape or wraparound bandage until medical care arrives. Don’t allow your child to eat anything, in case surgery is needed.
Let us start from the basics: what are bones made of? The main component of a bone is bone matrix, which is a mixture of a fibrous protein called collagen and an inorganic compound mostly made of calcium and phosphate. All bones have an outer surface called periosteum, a very thin membrane with nerves (that cause pain) and blood in it. The compact bone is the smooth and very hard part of the bone: it’s what we see when looking at the skeleton. The spongy bone is lighter than compact bone, but still very strong. The inside parts of a bone are hollow, and they are filled with a kind of jelly called bone marrow.
The bones of a human skeleton are classified in two major types: the axial skeleton and the appendicular skeleton. Axial skeleton has about 80 bones and appendicular skeleton has 126 bones. The main functions of the skeleton are to give shape to our body, provide attachment for muscles and produce red blood cells.
The longest, largest and hardest bone is the thigh bone, also known as femur:
There are 5 types of bones in the human body:
Fractures heal at different rates, depending on the age of the child and type of fracture, but in general a child’s bone heals faster than an adult’s one, due to some differences in the bone structure. For instance, in children the periosteum is thicker, stronger and more active to better supply oxygen and nutrients to the growing bones, and this helps in case of fracture. Its inner part contains very vital cells able to produce new bone. So, if an injury or an accident unfortunately occur to your child’s bone, these cells are able to renew and remodel the broken bone. There is also a surgical operation called osteotomy in which a bone is cut on purpose by the surgeon to readjust or correct the bone’s alignment.
There are several types of bone fractures that may occur in children, including for example:
The most frequent treatment options for bone fractures are:
The needed treatment will depend on the type of fracture.
The treatment your child needs will depend on the type of fracture, age, overall health and medical history. Each child is different and your orthopaedic surgeon – a doctor specialized in conditions related to bones health, ligaments, tendons and muscles – will discuss with you the necessary and best treatment for your child’s fracture. Your surgeon will also share with you your child’s recovery plan, and will be near you along the entire treatment to ensure the healing is proceeding as intended.
In case your child’s limb has been realigned with the use of an external fixator, your surgeon will give you an estimate of how long your child’s recovery will take, as it depends on every specific situation: type of fracture/s, child’s age, overall child’s health and other co-factors. During the healing process, it’s important that your child stays active and starts mobilizing as soon and safely as possible: playing, going back to school, keeping on his/her daily routines. When back home, your child should meet other children and friends, enjoying their company to overcome the initial stress and limitations, and always following the instructions provided by the surgeon and hospital staff.
The pin-site is the area of skin crossed by pins or wires of the external fixator: it has to be checked carefully every day, and kept constantly clean to prevent infections at your child’s limb. It’s very important that you follow exactly the instructions provided by your surgeon and hospital staff.
The hardware will be removed from your child’s limb when the surgeon is completely satisfied with the alignment and consolidation of the bone. It can also happen that your child needs to wear a cast for a short while after the fixator frame has been removed.
Building healthy bones can be obtained adopting a healthy nutritional and lifestyle habits in childhood, to help prevent osteoporosis and fractures later in life. One of the best ways to encourage healthy habits in your children is to be a good role model yourself. Children watch us, and our habits have a strong influence on theirs. The two most important lifelong bone health habits are proper nutrition - a varied and balanced diet with the right amount of the essential elements plus calcium and vitamin D - and physical activity.
In case of bone fracture, you should:
An X-rays is generally used to diagnose the type of fracture and whether or not the bones are in line (if there is a displacement or not). Although X-rays reveals most fractures, including subtle fractures in skeletally immature children, in some cases (for instance, occult physeal fracture) the fracture detection may be improved by using magnetic resonance imaging (MRI) or computed tomography (CT or CAT scan).
Physiotherapy exercises are very important for your child’s limb healing. Physiotherapy makes sure that his/her bones are surrounded and supported by healthy, strong muscles, and his/her joints go on functioning well, preventing permanent joint stiffness. These exercises must be constantly practised, under the supervision of a qualified physiotherapist.