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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Fractures

fractureThe word “fracture” is used to describe a broken bone of any size. Fractures are the fourth most common injury in children under age 6. This is unsurprising considering the activities of childhood - running, jumping, climbing and falling. Children’s bones are more flexible and have a thicker covering than adults, allowing them to act as shock absorbers and not break as easily. However, if a child’s bone is under too much pressure, it can still break but tends to heal rapidly and well. Children’s fractures are mostly caused by falls and rarely require surgical repair. Minor breaks need to be kept free of movement and casts are generally used to facilitate healing and relieve pain. In the case of more severe injuries or accidents, surgical and orthopedic intervention may be necessary, to realign the break, prevent infection, and minimize the risk of future growth problems.

Types of fractures:

“Green stick” fractures are partial fractures that tend to occur in the middle of long bones, such as the arms or legs. The bone bends like a green wood tree and breaks on one side.

“Torus” fractures occur when the bone collapses in on itself, becoming buckled, twisted or weakened without a complete break.

Green stick and torus fractures are the most common fractures occurring in children.

“Complete” fractures in which the bone breaks all the way through, also occur in young children. Fractures are classified as “non-displaced”, if the broken bone ends are still aligned or in proper position; or “displaced” when the ends of the bone are separated or out of alignment. In an “open” or “compound” fracture, the broken bone protrudes through the skin. If the skin is intact over the bone, the fracture is said to be “closed”.

In the case of a “stress” or “hairline” fracture, a break develops in the bone due to repeated force against the bone.

Children are vulnerable to additional type of fracture that does not occur in adults, called a “growth plate” fracture. This involves damage to the growth plate or area of developing cartilage tissue near the end of long bones. Growth plates are important because they regulate the length and shape of mature bones.

Common fractures in young children:

A very common fracture, accounting for 40-50% of breaks in young children is just above the wrist, in the big forearm bone called the radius. If a child falls and lands on their outstretched arm and hand with significant force, their radius can break.

“Buckle” fractures occur when newly grown bone scrunches under pressure, forming a kink. Children commonly sustain this type of fracture in their outer forearms, when throwing out their arms to break a fall.

A “toddler’s fracture”, also called a “childhood accidental spiral tibial fracture (CAST), is an isolated fracture in the large bone of the lower leg (tibia). It generally occurs when a child’s foot gets caught during a fall, putting some torque on the leg. This type of fracture is difficult to see on X-ray and may only be diagnosed a week or so later on repeat X-ray, or with a bone scan.

Signs and symptoms:

It is not always easy to tell if a child has a broken bone, especially if they are unable to describe how they are feeling. Common signs include:

  • A snapping sound
  • Bruising
  • Swelling
  • Tenderness to touch
  • Warmth over the affected area, which indicates inflammation
  • Severe pain, especially in one area (localized)
  • Increased pain with movement
  • Persistent pain (most bumps and bruises settle within 48-72 hours)
  • Stiffness
  • Severe distress
  • An inability or unwillingness to move a limb or digit. However, just because a child can move the affected area doesn’t necessarily rule out a fracture. Contact your paediatrician immediately if you suspect a bone is broken.
  • A limb or joint that seems to be out of position.
  • Holding a limb in a guarded way.

Home treatment:

Until your child can be seen in the pediatrician’s office or emergency room, follow the ICES guideline:

Ice – Apply an ice pack or crushed ice wrapped in a cloth or plastic bag, to the affected area for 20 minutes at a time. A cold compress alleviates pain and reduces inflammation. In babies and toddlers, rather use a cold towel as extreme cold can damage their delicate skin.

Compression – Firmly wrap an elastic or fabric bandage around the injured limb. Ensure that it is snug not tight, by fitting one finger between the bandage and the skin. Check the area frequently as additional swelling will make the bandage too tight.

Elevation – If you can get your child to lie still, place a pillow under the affected limb so that it is elevated about 6 inches above the heart Elevation decreases pain and swelling.

Support – If immediate medical attention is unavailable, use an improvised sling or splint to protect the injury from unnecessary movement. If you suspect a broken arm, shoulder or rib, place the arm on the injured side in a cloth or diaper sling. Tie the sling around the shoulder on the opposite side. Create a finger support by placing a piece of cloth or cotton between the injured finger and an uninjured one, and tape the two fingers together.  To splint a leg, roll up a blanket and place it between your child’s legs. Tie their legs together (with cloth strips, ties or shoelaces) at the groin, thigh, knee and ankle. Alternatively, find a solid, straight object to use as a splint, such as a ruler, paper towel roll, or rolled up magazine. Select an object that is slightly longer than the bone and joint you are supporting. Wrap the object with a diaper or soft cloth to protect the skin. Hold it next to the injured limb, and tie it in place at the joints above and below the injury. Immobilizing the injury prevents further damage; however if it causes your child distress, take him or her to the emergency room.

DO NOT:

  • Try and straighten or change the position of a broken bone.
  • Give your child anything to eat or drink without consulting your doctor. This precaution is necessary for surgical purposes, because it is risky to give an anaesthetic with food or fluid in the stomach and it may delay treatment.
  • Try and move your child if they have a broken leg. Call an ambulance and allow paramedics to supervise the transportation.
  • Try placing protruding bone back underneath the skin, if it is exposed.

IF:

An injury is open and bleeding, or if the bone is protruding through the skin, apply firm pressure to the wound, and cover it with sterile gauze. An open fracture is the most dangerous type of break, due to the risk of bleeding and infection, and requires immediate medical intervention.

Diagnosis:

After examining the affected area, the doctor will order X-rays to determine the extent of the damage. If he suspects damage to the growth plate, or if the bones are displaced, an orthopedic consultation will be necessary.

Treatment:

How a fracture is treated depends on several factors, including the location and severity of the break, and the child’s age.

For minor fractures, children usually require a plaster or fiberglass cast, or immobilizing splint for adequate healing to take place. Casts are needed to keep the broken ends of the bone together and shield it from further injury. While plaster is cheap, easily molded and more flexible; fiberglass is light, durable and more water-resistant. If a limb is swollen, plaster may be used and replaced when the swelling subsides. The type of casting material chosen generally depends on the amount of wear and tear the cast is expected to sustain and the practicality of shaping a cast around a particular injury.

Open fractures require surgical intervention, as they need to be washed out in an operating room to prevent infection. For a displaced fracture, an orthopaedic surgeon may need to realign the bones in a procedure called “closed reduction”. The surgeon uses local or general anesthesia, manipulates the bones until they are straight, and then applies a cast. When a child has other injuries that need monitoring, or if a broken bone won’t remain in alignment with a cast, doctors surgically repair broken bones with screws, plates or rods. This surgical procedure, known as “open reduction” is rarely required for children.

Fractures involving a joint or growth plate are more likely to need the skill and expertise of a paediatric orthopedic surgeon, to minimize the risk of future bone problems. If this part of the bone does not heal correctly after the fracture, the bone may grow at an angle or at a slower rate than other bones in the body. Unfortunately, the impact on the bone’s growth may only be visible a year or more after the injury is sustained. Bone growth fractures require careful follow-up with a paediatrician for 12-18 months to ensure that no damage has occurred.

When a school-aged child breaks their femur (thigh bone), a treatment called external fixation may be recommended instead of a chest-to-toes cast. This involves fastening the bones in place with screws that stick out through the skin and are connected by metal bars. External fixation poses a small risk of serious infection and does produce scars but simultaneously allows for greater mobility. Children can bend at the knee and hip, and under favourable circumstances, can return to school after a few weeks.

In terms of pain, splints and casts alone usually offer considerable relief. Your doctor may prescribe pain reduction medication, elevation and distraction, such as TV.  If your child experiences an increase in pain, numbness, or pale blue fingers or toes, call your doctor immediately. This is an indication of further swelling and the cast needs to be adjusted or replaced. Similarly, if the cast breaks, loosens significantly, or if the plaster becomes wet and soggy, it will not hold the broken bone in the correct position for healing.

Prevention:

Childproof your home and supervise your toddler at all times. Ensure the correct installation of a safe car seat that is suitable for your child’s age and size. As your toddler grows and becomes more active, have him wear protective gear when biking, roller blading, or participating in contact sports.

Prognosis:

Accidents do happen but most fractures in children are easy to treat, heal quickly (in half the time that adult bones require) and well. Healing time depends on the type of fracture and the child’s age, a simple fracture may mend in 2-3 weeks, whereas a more severe fracture can take 6-8 weeks. Young bones also don’t need to be in perfect alignment for successful healing to occur. Bones that are more or less in the right place will remodel as they grow. Your paediatrician may periodically monitor the healing process using X-rays, to ensure the bones are in satisfactory alignment.

When the cast is removed, expect a smell from the skin that will dissipate within a few days. The muscles in the affected area will weaken. Physical therapy may be necessary to rebuild muscle strength and balance. Body hair may grow longer and darker, but typically returns to normal within a few months. Follow your doctor’s recommendations regarding sport and exercise. Recently healed bone is stiffer and more vulnerable to further injury.

fracture stats-800p


http://www.healthychildren.org/English/health-issues/injuries-emergencies/Pages/Children-And-Broken-Bones.aspx

http://www.everydayfamily.com/toddlers-do-break-bones/

http://www.babycenter.com/0_broken-bones_11236.bc

http://www.whattoexpect.com/toddler/childhood-injuries/broken-bones-in-children.aspx

http://www.todaysparent.com/family/family-health/fracture-facts/