Do you know that between birth and age OF 16, the chance of kids and adolescents to get bone fractures are around 42% for boys and 27% for girls? The statistic is presented by UNSOM Primary Care Sports Medicine Fellow in 2014. In other words, the chance of your kids to get fractures is quite high. At some point in between birth and adolescent, 4 out of 10 boys will get fractures. And although this is a common incident among kids, bone fractures can be quite scary.
Fractures in children may occur in the shaft of the bone, or near the end, or in the joint. The most common fractures in children are in the area of distal radius, hand, elbow, clavicle, radial shaft, tibial shaft, foot, ankle, femur, and humerus. The types of fractures tpically occur to children are Salter Harris fractures, distal radius fractures (torus fractures and greenstick fractures), clavicular fractures, tibial shaft fractures, and radial head subluxation or nursemaid elbow.
Salter Harris Fractures
A Salter Harris fracture is a fracture that occurs in growth plate or the epiphyseal plate. Growth plates are bands of softer cartilage near the end of the bone that allow the bone to stretch as it grows. Fractures in the growth plate could affect the bone’s growth, but in many cases they heal well without later deformity.
In children, the growth plate is up to five times weaker than the ligaments that stabilize the adjacent joint. Salter Harris fractures are a common injury found in children. It occurs in 15% of childhood long bone fractures.
There are five types of Salter Harris growth plate fractures:
Type 1—a fracture that breaks straight through the physis (growth plate line).
Type 2—a fracture that goes above the physis. This is the most common Salter Harris fracture occurred in children, i.e. about 75% of the case.
Type 3—a fracture that originates anatomically below the physis and then cuts through the physis.
Type 4—a fracture that starts either below or above the physis, goes through the physis, and then out through the other side.
Type 5—a fracture that crush or rammed the plate growth and it can disturb the growth of the bones. But Salter Harris fracture is very rare.
Salter Harris fracture is a big problem because it can result in an abnormal growth of the bone. Salter Harris type 1 and 2 are non-displaced and can be treated by casting and it usually heals well. The doctors will monitor the recovery for 3-6 months after the initial injury to make sure that the bone growth is normal. Otherwise, further treatment may be required.
Although Salter Harris type 1 and 2 are typically non-displaced, Salter Harris type 3-5 fractures should be referred to an orthopedist. Children who get Salter Harris fractures need immediate attention. The growth plate needs to be put back into its correct anatomical position. It is because the growth plate is generating the new cells for that bone so it can grow properly. And if the growth plate is not in the right alignment, the children cannot get a proper growth.
Distal Radius Fractures
The Distal Radius Fracture cases that are often found in children are Torus fractures and Greenstick fracture.
Torus fracture is also called a “buckle” fracture. It occurs when the topmost layer of bone is compressed and makes the other side of the bone to bend away from the growth plate. A simple buckle fracture can occur due to axial force on immature bones.
Torus fracture is non-displaced (the broken pieces of bone have not separated apart). It can be managed using removable volar splint and immobilization for 2-4 weeks. Children with torus fracture typically heal well with no complications after the recovery.
Greenstick fracture occurs when the fracture extends through a portion of the bone until it to bend on the other side. The severe bending force on the distal radius causes compression fracture at dorsum of distal radius. If the fracture is non-displaced, it can be managed with short arm cast. But if the greenstick fracture is displaced more than 15 degrees of angulation, it can be treated with long arm cast. The elbow needs to be placed in 90 degrees of flexion.
Being treated using short arm cast, the non-displaced greenstick fracture typically recovers in about 4 weeks. It may takes longer for displaced greenstick fractures to fully recover.
Clavicular fractures usually occur in middle third of clavicle. It may be caused by falling onto shoulder, direct blow to clavicle, or impulsive force from injury. The symptoms include pain that comes with shoulder motion and often visible bulge on the fracture site. Children may also feel tenderness, crepitus, ecchymosis, and skin tenting.
Clavicular fracture is quite fatal as it may leave some kind of bony deformity. In some cases, clavicular fractures are followed by complications such as pneumothorax, hemothorax, or vascular compromise.
The fracture can be treated with clavicle strap or arm sling (for non-displaced fractures). During the treatment that last for 3-6 weeks, patients are immobilized until the fracture site is no longer tender. One to two months after the recovery, patients are not allowed to do sport activities in order to avoid re-injury.
Tibial Shaft Fracture
Tibial Shaft Fracture is typically caused by a fall with twisting motion or a fall from a significant height. Tibial Shaft Fracture is painful and often followed by swelling over the fracture site. And patients with Tibial Shaft Fracture are unable to bear weight.
Tibial Shaft Fracture is usually non-displaced and can be treated with a bent knee long-leg cast. It usually takes 3-4 weeks for the fractures to get better, followed by leg walking cast for 3-4 weeks. Normally it takes 6-10 weeks to fully recover.
Radial Head Subluxation
Radial Head Subluxation is also called “nursemaid’s elbow”. It commonly occurs to toddlers at the age 2-3. The injury is usually accidental, caused by sudden longitudinal traction on arm with elbow extended. Parents need to be careful when lifting their toddlers on their stretched hands, as the culprit of Radial Head Subluxation cases are usually the caretaker.
The symptoms of Radial Head Subluxation include pain and unable to use the affected arm. The injury can be treated with supination/flexion. Radial Head Subluxation not a serious condition and the recovery is quite fast.
Children get injured all the time when they play, and adults should always provide careful attention when it happens. If their hands or forearms do not look alright after the incident, the children should be brought immediately to see doctors.
Be informed that most fractures are noticeable, but some are not. They do not always look crooked or in abnormal alignment. Some fractures may only leave bruising or swelling on the skin, and can only be confirmed with an x-ray.
Children frequently do many activities that put them at risk for injuries and even fractures. Many cases on bone fractures occur, not in seemingly dangerous places, but on the playground. They may lose their grip on the playing equipment, causing them to fall. Fractures may also occur in recreational activities and sports, such as football or bicycling.
As a prevention method, it is advised to always look out for toddlers while they are playing. For older children, give them protective equipment such as elbow and knee pads while cycling to reduce the risk of a fracture.