Bone Fractures Information

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Bone Fractures

A child's bone is generally much more flexible than an adult's. It is covered witha fairly thick layer of fibrous tissue called periosteum, which contributes to heal-

Iing if the bone should fracture. At each end of long bones (such as the shinbone)there is an area known as the growth plate, where growth in length and width ofthe bone takes place. The fastest growing growth plates are the lower end of thefemur (thighbone) and the upper end of the tibia (shinbone). Growth plates dis-appear completely during adolescence.

Fractures

As a child grows, gains weight, and becomes more mobile, falls and other acci-dents can exert enough stress on a bone to cause a fracture, or break. There areseveral types of fractures.

Nondisplaced fracture. Sometimes a bone breaks completely but the pieces arenot separated. Depending upon the location of the fracture, it will be straight-ened (if necessary) and then immobilized in a splint or cast for a period of timerecommended by the treating physician.

Greenstick fracture. If you have ever taken a fresh branch off a tree and tried tobreak it, you may have noticed that one side of the branch may break while theother side bends. The same phenomenon canoccur in a child's bone; this is called a greenstickfracture. The treatment is the some as for anondisplaced fracture.

Displaced fracture.

This occurs when the bone breaks completely, and the broken ends moveassay from one another. This will be treated inone of three ways:

•In a closed reduction, the child is usuallysedated or given a general anesthetic, andthe doctor then attempts to move the brokenpieces into proper alignment. If the proce-dure is successful, a cast is applied for stabi-lization until the fracture heals.

•Sometimes the broken ends of the bone canbe brought together, but they are so unstable that they will not remainin proper alignment, even with a cast. In such cases metal pins areinserted into the bone to hold the pieces together. This is done underanesthetic, and usually a splint or cast is applied afterward. Dependingupon the location of the fracture, the pins will be left in place for a fewweeks and then removed.

•If the ends of the fractured bone cannot be brought together by a closedreduction, an open reduction will be performed to accomplish thisgoal. In this case, the surgeon has to make an incision in the region ofthe fracture to be able to see the bone ends directly. The alignment iscorrected and is often held in place with pins or a plate and screws.

Open fracture. This injury, in which one end of a fractured bone protrudesthrough the skin, is an urgent situation. The wound should be covered and thechild taken immediately to the nearest emergency room. Often, open fracturesare contaminated with dirt, grass, clothing, etc. The surgeon will attempt to re-move all of the debris to reduce the chance of infection. Antibiotics should begiven. Usually the wound is not sutured together right away, but it may bedosed later if there is no sign of infection.

Sometimes weeks after a child has suffered a fracture, the bone will appearcrooked, even though the healing process is going well. Because bone is a livingtissue, it not only heals but also undergoes remodeling, a process by which thegrowth plate and periosteum gradually correct the deformity. If you see an X-rayof the same bone years later, you may find it hard to tell that it was ever broken.

Remodeling cannot correct all deformities, however, and the ability of bones owremodel decreases as a child gets older. If a fracture involves the growth plate_ acrooked and/or short limb occasionally results, and surgery may be required wcorrect this problem.

Sprains

To move properly in relation to each other, the joint between adjacent bones is

by strong but flexible fibrous bands called ligaments that help keep the bonesproper alignment. A sudden, forceful twisting motion can cause stretching or teamsof a ligament, better known as a sprain. This will typically produce pain when a dlialattempts to move or put weight on the affected area, as well as swelling and often abluish discoloration. Since sprains are more common in adults than in children andsince it may be difficult to determine if a fracture is present merely by looking at asinjured arm or leg, a child with these symptoms should be evaluated by a physician

The simple acronym RICE can help you remember the steps to take follow-ing a sprain:

•Rest the injured area.

•Ice or cold packs can decrease swelling and pain, but their contact withskin should he limited to 20 minutes three to four times a day.

•Compression, such as an elastic wrap around the affected area, can alsoreduce swelling and pain. (This should not be tight enough to causediscomfort, numbness, or tingling.)

•Elevate the injured area as much as possible for 24 hours to help reduceuncomfortable swelling.

Dislocations

When this happens, the relationship of the two bones that make up a joint is dis-rupted. In a dislocation of the hip, the ball comes out of the socket. The areasmost commonly affected are the shoulder, elbow, kneecap, and fingers.Frequently, there is an associated fracture. Dislocations are best treated byphysician (not by untrained bystanders) and will likely require sedating medica-tion or a general anesthetic to relax surrounding muscles before the bones areput back in their proper relationship. The injured area is usually protected for afew weeks and followed by a gradual return to normal activities. Shoulder andkneecap dislocations often occur repeatedly after the initial episode; sometimessurgery is needed to prevent further episodes. A common dislocation in younger children is the so-called nursemaid's el-bow, which occurs when a toddler or preschooler is tugged forcefully by one arm.-,ften the injury takes place when an adult is holding the hand of a child whotrips while walking. The adult may actually pull upward in an effort to stop thefall. This causes the upper end of the radius (one of two bones in the forearm) toslip through a ring of fibrous tissue that normally holds it in place. Afterwards,tie child's arm may hang limp at his side, and the child will protest loudly if any-one attempts to move it. Often a doctor can resolve this type of dislocation withsimple maneuver. Normally this quickly resolves the pain, and soon afterward.e child will begin using the arm again.

Sprains

During vigorous exercise, muscles may be stretched or even torn, resulting in astrain. This will cause pain and tenderness of the muscle itself - for example, thefront of the thigh following repetitive jumping or a day of skiing - rather than, iin in a joint that a sprain would cause. Most strains can be treated at home with rest, ibuprofen, acetaminophen, and gentle ice massage for 20 minutes threefour times a day. If the pain is severe or does not improve after 48 hours, thelad should be evaluated by the physician. A child or adolescent who has had-oblems with strained muscles should be taught to do gentle stretching exer-ses prior to any strenuous exertion.

Tendottitis

Tendons are fibrous tissues that attach muscle to bone. Some tendons, such asthose extending to the fingers, are quite long. Repetitive use of certain musclesmay cause local inflammation known as tendonitis at or near the attachmentsite. If your child's doctor diagnoses this problem, avoidance of activities thatprovoke pain and possibly the use of anti-inflammatory medications such asibuprofen may be recommended until the pain resolves

Bone Fracture First Aid

Some fractures are obvious, and others are suspecteden significant pain, swelling, or discoloration followinjury. If you know or suspect that your child has:tured a bone, do the following:

Make sure he avoids putting pressure or weight on it.Gently splint the affected area to reduce pain andthe risk of further damage. For an arm injury, asimple sling or a magazine held against the arm withan elastic wrap will usually be adequate. A leg maybe splinted by carefully binding it to the other legwith a towel placed between them.

Don't try to manipulate fractures or dislocations unlessyou are trained to do so and you are certain of thenature of the injury. Significant additional injury can occurthrough inappropriate movement of an injured limb.

•If possible, cover any open wounds to preventfurther contamination.

•Don't give the child anything to eat or drink until theinjuries have been evaluated and it is clear thatsurgery will not be needed.

•Take the child to the nearest emergency departmentfor treatment.

•If the neck appears to be injured it is very importantthat the child only be moved by people trained todeal with this type of injury. This is an emergency,and assistance should be sought immediately bycalling 911. While waiting, keep the child frommoving as much as possible. The transport team willcarefully apply a neck brace and place the child on aspine board.

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