Child bone fracture

Last updated December 03, 2023

A child bone fracture or a pediatric fracture is a medical condition in which a bone of a child (a person younger than the age of 18) is cracked or broken.^[1] About 15% of all injuries in children are fracture injuries.^[2] Bone fractures in children are different from adult bone fractures because a child's bones are still growing. Also, more consideration needs to be taken when a child fractures a bone since it will affect the child in his or her growth.^[3]

On an everyday basis bones will support many kinds of forces naturally applied to them, but when the forces are too strong the bones will break. For example, when an adolescent jumps off of a trampoline and lands on his/her feet the bones and connective tissue in the adolescent's feet will usually absorb the force, flex, then return to their original shape. However, if the adolescent lands and the force is too strong, the bones and the connective tissue will not be able to support the force and will fracture.^[4]

Types of fractures

The bones of a child are more likely to bend than to break completely because they are softer and the periosteum is stronger and thicker.^[3] The fractures that are most common in children are the incomplete fractures; these fractures are the greenstick and torus or buckle fractures.^{[ citation needed ]}

Greenstick fracture

This fracture involves a bend on one side of the bone and a partial fracture on the other side. The name is by analogy with green (i.e., fresh) wood which similarly breaks on the outside when bent. The Sub-nanostructure of cortical bone may provide one possible explanation for the greenstick fractures in children. On the contrary to adults bone tissue, the low ratio between the mature and the immature enzymatic cross-links in children bone tissue is a potential explanation of the presence of greenstick fractures in children.^[5]

Torus or buckle fracture

This fracture occurs at the metaphyseal locations and resemble the torus or base of a pillar in architectural terms. Acute angulation of the cortex is noted, as opposed to the usual curved surface. It is caused by impaction. They are usually the result of a force acting on the longitudinal axis of the bone: they are typically a consequence of a fall on an outstretched arm, so they mainly involve the distal radial metaphysis. The word torus is derived from the Latin word 'torus,' meaning swelling or protuberance.^{[ citation needed ]}

Bow fracture

The bone becomes curved along its longitudinal axis.^[6]

Hairline fracture

An incomplete fracture (a thin crack in the bone that doesn't go all the way through the bone.)^{[ citation needed ]}

Single fracture

The bone is fractured only in one place.^{[ citation needed ]}

Segmental fracture

Fracture in two or more places in the same bone.^{[ citation needed ]}

Comminuted fracture

The bone fractures in more than two places or is crushed into pieces.^[7]

Corner or bucket-handle fracture

A corner fracture or bucket-handle fracture is fragmentation of the distal end of one or both femurs, with the loose piece appearing at the bone margins as an osseous density paralleling the metaphysis.^[8] The term bucket-handle fracture is used where the loose bone is rather wide at the distal end, making it end in a crescent shape.^[9] These types of fractures are characteristic of child abuse-related injuries.^[10]

Other ways to describe a fracture

Closed fracture

A fracture that doesn't penetrate the skin.^{[ citation needed ]}

Open (compound) fracture

A fracture resulting in the ends of a bone penetrating the skin (these pose an increased risk of infection).^{[ citation needed ]}

Non-displaced fracture

A fracture where the bone cracks completely and the pieces line up.^{[ citation needed ]}

Displaced fracture

A fracture where the bone cracks completely in two or more pieces, and the pieces move out of alignment (this type of fracture might require surgery to make sure the pieces are aligned before casting).^{[ citation needed ]}

Symptoms and signs

Even though symptoms vary widely after experiencing a bone fracture, the most common fracture symptoms include:

pain in the fractured area
swelling in the fractured area
obvious deformity in the fractured area
not being able to use or move the fractured area in a normal manner
bruising, warmth, or redness in the fractured area^[4]

Cause

Children with a higher risk of a fracture

Low bone mineral content

Children with generalized disorders such as renal diseases, cystic fibrosis, diabetes mellitus, growth hormone deficiency, and osteogenesis imperfecta disorders are at risk.^[11] Neuromuscular disorders: children with cerebral palsy, spina bifida, and arthrogryposis, have a higher risk of a fracture because of the combination of joint stiffness and poor mineralization.^[11]

Fracture personality

Children in general are at greater risk because of their high activity levels. Children that have risk-prone behaviors are at even greater risk.^[11]

Child abuse

Over 2.5 million child abuse and neglect cases are reported every year, and thirty-five out of every hundred cases are physical abuse cases.^[12] Bone fractures are sometimes part of the physical abuse of children; knowing the symptoms of bone fractures in physical abuse and recognizing the actual risks in physical abuse will help forward the prevention of future abuse and injuries.^[12] Astoundingly, these abuse fractures, if not dealt with correctly, have a potential to lead to the death of the child.^[12] Fracture patterns in abuse fractures that are very common with abuse are fractures in the growing part of a long bone (between the shaft and the separated part of the bone), fractures of the humeral shaft (long bone between the shoulder and elbow), ribs, scapula, outer end of the clavicle, and vertebra. Multiple fractures of varying age, bilateral fractures, and complex skull fractures are also linked to abuse. Fractures of varying ages occur in about thirteen percent of all cases.^[12]

Pathophysiology

Differences between child and adult bones

There are differences in the bone structure of a child and an adult. These differences are important for the correct evaluation and treatment of the fractures. A child's bones heal faster than an adult's because a thicker, stronger, and more active dense fibrous membrane (periosteum) covers the surface of their bones.^[13] The periosteum has blood vessels that supply oxygen and nutrition to the bone cells. The stronger and thicker periosteum in children causes a better supply of oxygen and nutrients to the bones,^[14] and this helps in faster remodeling of the fractured bones. The periosteum in children causes a more rapid union of fractured bones and an increased potential for remodeling.^[13] A child's fractures not only heal more quickly, but are significantly reduced due to the thickness and strength of a child's periosteum. But this thickness also has its drawbacks; when there is a small displacement in the periosteum the thickness and strength of it will make the fracture in the periosteum difficult to diagnose.^[13]

Growth plate

Growth plates are the areas in bones where the bones grow.^[15] In children the growth plates are open, which helps to manage a child's fractures.^{[ citation needed ]}

Age and sex related fractures

Bone fracture types differ depending on the age and sex of the child. The changes in the bones over time cause variance in the pattern and number of bone fracture injuries. The probability of bone fractures in children increases with age.^[16] For a small child, injuries will most likely be minimal because the child doesn't have the speed or mass to cause serious injuries.^[16] When age increases, so does mass and speed resulting in more serious fractures. The age when girls usually fracture a bone is twelve and for boys the age is fourteen.^[16] Also, girls statistically have fewer fractures than boys. About half of boys and one-fourth of girls are likely to have a fracture during childhood. The wrist is also the most likely part of the body to be injured. As sport activities increase, the fractures in children increase as well, especially for boys who participate in either wrestling or football. Much like bone types in the different stages of childhood are varying, so the bone fracture injuries in infants, children, and adolescents vary. Careful evaluation for the best treatment of each child is needed.^[16]

Treatment

When a child experiences a fracture, he or she will have pain and will not be able to easily move the fractured area.^[4] A doctor or emergency care should be contacted immediately. In some cases even though the child will not have pain and will still be able to move, medical help must be sought out immediately.^[4] To decrease the pain, bleeding, and movement a physician will put a splint on the fractured area. Treatment for a fracture follows a simple rule: the bones have to be aligned correctly and prevented from moving out of place until the bones are healed.^[4] The specific treatment applied depends on how severe the fracture is, if it's an open or closed fracture, and the specific bone involved in the fracture (a hip fracture is treated differently from a forearm fracture for example)^[4] Different treatments for different fractures:^[4] The general treatments for common fractures are as follows:

Cast immobilization

Because most fractures heal successfully after having been repositioned, a simple plaster or fiberglass cast is commonly used.^[4]

Functional cast or brace

A cast, or brace, that allows limited movement of the nearby joints is acceptable for some fractures.^[4]

Traction

This treatment consists of aligning a bone or bones by a gentle, steady pulling action. The pulling may be transmitted to the bone or bones by a metal pin through a bone or by skin tapes. This is a preliminary treatment used in preparation for other secondary treatments.^[4]

Open reduction and internal fixation

This treatment is only used when an orthopedic surgeon assigns it to restore the fractured bone to its original function. This method positions the bones to their exact location, but there is a risk for infection and other complications. The procedure involves the orthopedist performing surgery on the bone to align the bone fragments, followed by the placement of special screws or metal plates to the outer surface of the bone. The fragments can also be held together by running metal rods through the marrow in the center of the bone.^[4]

External fixation

This treatment also requires surgery by an orthopedist. Pins or screws are placed into the fractured bone above and below the fracture site. The orthopedic surgeon repositions the bone fragments and pins or screws are connected to a metal bar or bars outside the skin which holds the bones in their proper position so they can heal. The external fixation device is removed after an appropriate time period.^[4]

Prognosis

Fractures in children generally heal relatively fast, but may take several weeks to heal.^[17] Most growth plate fractures heal without any lasting effects.^[17] Rarely, bridging bone may form across growth plates, causing stunted growth and/or curving.^[17] In such cases, the bridging bone may need to be surgically removed.^[17] A growth plate fracture may also stimulate growth, causing a longer bone than the corresponding bone on the other side.^[17] Therefore, the American Academy of Orthopaedic Surgeons recommends regular follow-up for at least a year after growth plate fractures.^[17]

Related Research Articles

Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.

$Bone fracture Physical damage to the continuity of a bone$

A bone fracture is a medical condition in which there is a partial or complete break in the continuity of any bone in the body. In more severe cases, the bone may be broken into several fragments, known as a comminuted fracture. A bone fracture may be the result of high force impact or stress, or a minimal trauma injury as a result of certain medical conditions that weaken the bones, such as osteoporosis, osteopenia, bone cancer, or osteogenesis imperfecta, where the fracture is then properly termed a pathologic fracture.

$Distal radius fracture Fracture of the radius bone near the wrist$

A distal radius fracture, also known as wrist fracture, is a break of the part of the radius bone which is close to the wrist. Symptoms include pain, bruising, and rapid-onset swelling. The ulna bone may also be broken.

$Greenstick fracture Medical condition$

A greenstick fracture is a fracture in a young, soft bone in which the bone bends and breaks. Greenstick fractures occur most often during infancy and childhood when bones are soft. The name is by analogy with green wood which similarly breaks on the outside when bent.

$Clavicle fracture Medical condition$

A clavicle fracture, also known as a broken collarbone, is a bone fracture of the clavicle. Symptoms typically include pain at the site of the break and a decreased ability to move the affected arm. Complications can include a collection of air in the pleural space surrounding the lung (pneumothorax), injury to the nerves or blood vessels in the area, and an unpleasant appearance.

$Reduction (orthopedic surgery) Surgery to repair fractures or dislocations$

Reduction is a surgical procedure to repair a fracture or dislocation to the correct alignment.

A periosteal reaction is the formation of new bone in response to injury or other stimuli of the periosteum surrounding the bone. It is most often identified on X-ray films of the bones.

$Salter–Harris fracture Medical condition$

A Salter–Harris fracture is a fracture that involves the epiphyseal plate of a bone, specifically the zone of provisional calcification. It is thus a form of child bone fracture. It is a common injury found in children, occurring in 15% of childhood long bone fractures. This type of fracture and its classification system is named for Robert B. Salter and William H. Harris who created and published this classification system in the Journal of Bone and Joint Surgery in 1963.

$Open fracture Medical condition$

An open fracture, also called a compound fracture, is a type of bone fracture that has an open wound in the skin near the fractured bone. The skin wound is usually caused by the bone breaking through the surface of the skin. Open fractures are emergencies and are often caused by high energy trauma such as road traffic accidents and are associated with a high degree of damage to the bone and nearby soft tissue. An open fracture can be life threatening or limb-threatening due to the risk of a deep infection and/or bleeding. Other complications including a risk of malunion of the bone or nonunion of the bone. The severity of open fractures can vary. For diagnosing and classifying open fractures, Gustilo-Anderson open fracture classification is the most commonly used method. It can also be used to guide treatment, and to predict clinical outcomes. Advanced trauma life support is the first line of action in dealing with open fractures and to rule out other life-threatening condition in cases of trauma. The person is also administered antibiotics for at least 24 hours to reduce the risk of an infection. Cephalosporins are generally the first line of antibiotics. Therapeutic irrigation, wound debridement, early wound closure and bone fixation are the main management of open fractures. All these actions aimed to reduce the risk of infections. The bone that is most commonly injured is the tibia and working-age young men are the group of people who are at highest risk of an open fracture. Older people with osteoporosis and soft-tissue problems are also at risk.

The Boston brace, a type of thoraco-lumbo-sacral-orthosis (TLSO), is a back brace used primarily for the treatment of idiopathic scoliosis in children. It was developed in 1972 by M.E "Bill" Miller and John Hall at the Boston Children's Hospital in Boston, Massachusetts.

<span class="mw-page-title-main">Ignacio Ponseti</span>

Ignacio Ponseti was a Spanish-American physician, specializing in orthopedics. He was born on 3 June 1914 in Menorca, part of the Balearic Islands, Spain, Ponseti was the son of a watchmaker and spent his childhood helping repair watches. This skill was said to eventually contribute to his abilities as an orthopedist. He served three years as a medic during the Spanish Civil War treating orthopedic injuries of wounded soldiers. He left Spain shortly after the end of the war and became a faculty member and practicing physician at the University of Iowa, where he developed his ground-breaking, non-surgical treatment for the clubfoot defect - the Ponseti Method.

Epiphysiodesis is a pediatric orthopedic surgery procedure that aims at altering or stopping the bone growth naturally occurring through the growth plate also known as the physeal plate. There are two types of epiphysiodesis: temporary hemiepiphysiodesis and permanent epiphysiodesis. Temporary hemiepiphysiodesis is also known as guided growth surgery or growth modulation surgery. Temporary hemiepiphysiodesis is reversible i.e. the metal implants used to achieve epiphysiodesis can be removed after the desired correction is achieved and the growth plate can thus resume its normal growth and function. In contrast, permanent epiphysiodesis is irreversible and the growth plate function cannot be restored after surgery. Both temporary hemiepiphysiodesis and permanent epiphysiodesis are used to treat a diverse array of pediatric orthopedic disorders but the exact indications for each procedure are different.

$Toddler's fracture Medical condition$

Toddler's fractures are bone fractures of the distal (lower) part of the shin bone (tibia) in toddlers and other young children. The fracture is found in the distal two thirds of the tibia in 95% of cases, is undisplaced and has a spiral pattern. It occurs after low-energy trauma, sometimes with a rotational component.

$Mandibular fracture Medical condition$

Mandibular fracture, also known as fracture of the jaw, is a break through the mandibular bone. In about 60% of cases the break occurs in two places. It may result in a decreased ability to fully open the mouth. Often the teeth will not feel properly aligned or there may be bleeding of the gums. Mandibular fractures occur most commonly among males in their 30s.

<span class="mw-page-title-main">Internal fixation</span> Orthopedic operation to fix bone

Internal fixation is an operation in orthopedics that involves the surgical implementation of implants for the purpose of repairing a bone, a concept that dates to the mid-nineteenth century and was made applicable for routine treatment in the mid-twentieth century. An internal fixator may be made of stainless steel, titanium alloy, or cobalt-chrome alloy. or plastics.

Orthopedic surgery is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal injuries, sports injuries, degenerative diseases, infections, bone tumours, and congenital limb deformities. Trauma surgery and traumatology is a sub-specialty dealing with the operative management of fractures, major trauma and the multiply-injured patient.

Lynn Taylor Staheli was an American pediatric orthopedist. He was a founding editor of the Journal of Pediatric Orthopaedics and founder of Global HELP Organization, a nonprofit organization that provides free medical information in developing countries.

$Proximal humerus fracture Break of the upper part of the bone of the arm$

A proximal humerus fracture is a break of the upper part of the bone of the arm (humerus). Symptoms include pain, swelling, and a decreased ability to move the shoulder. Complications may include axillary nerve or axillary artery injury.

$Torus fracture Common type of fracture in children$

A Torus fracture, also known as a buckle fracture is the most common fracture in children. It is a common occurrence following a fall, as the wrist absorbs most of the impact and compresses the bony cortex on one side and remains intact on the other, creating a bulging effect. As the bulge is only on one side of the bone, this injury can be classified as an incomplete fracture. The compressive force is provided by the trabeculae and is longitudinal to the axis of the long bone, meaning that the fracture itself is orthogonal to that axis. The word "torus" originates from the Latin word "protuberance."

$Medial epicondyle fracture of the humerus$

A medial epicondyle fracture is an avulsion injury to the medial epicondyle of the humerus; the prominence of bone on the inside of the elbow. Medial epicondyle fractures account for 10% elbow fractures in children. 25% of injuries are associated with a dislocation of the elbow.

References

↑ Berteau JP, Gineyts E, Pithioux M, Baron C, Boivin G, Lasaygues P, Chabrand P, Follet H (2015). "Ratio between mature and immature enzymatic cross-links correlates with post-yield cortical bone behavior: An insight into greenstick fractures of the child fibula" (PDF). Bone. 79: 190–5. doi:10.1016/j.bone.2015.05.045. PMID 26079997.
↑ Staheli, Lynn, Fundamentals of Pediatric Orthopedics p. 119.
1 2 Broken Bones in Children Information about fractures in young patients By Jonathan Cluett, M.D., About.com Updated: August 29, 2005 Retrieved Sep. 2008 <http://orthopedics.about.com/od/fracturesinchildren/Information_About_Fractures_In_Children.htm Archived 2013-05-14 at the Wayback Machine >
1 2 3 4 5 6 7 8 9 10 11 12 What Is a Bone Fracture and How Is it Treated? www.kidsgrowth.com. Oct. 24, 2008. Retrieved Oct. 2008 < http://www.kidsgrowth.com/resources/articledetail.cfm?id=1504 Archived 2018-02-02 at the Wayback Machine >
↑ Berteau, Jean-Philippe; Gineyts, Evelyne; Pithioux, Martine; Baron, Cécile; Boivin, Georges; Lasaygues, Philippe; Chabrand, Patrick; Follet, Hélène (2015-10-01). "Ratio between mature and immature enzymatic cross-links correlates with post-yield cortical bone behavior: An insight into greenstick fractures of the child fibula" (PDF). Bone. 79: 190–195. doi:10.1016/j.bone.2015.05.045. ISSN 1873-2763. PMID 26079997.
↑ Jeremy Jones. "Bowing fracture". Radiopaedia.org. Retrieved 20 November 2014.
↑ Broken Bones, kidshealth.org, Reviewed by: Peter G. Gabos, MD Date reviewed: April 2008. Retrieved Sep. 2008
↑ thefreedictionary.com > bucket handle fracture citing: McGraw-Hill Concise Dictionary of Modern Medicine. 2002
↑ Bucket Handle and Corner Fractures Radiology Cases in Pediatric Emergency Medicine. Volume 4, Case 2. Rodney B. Boychuk, M.D. Kapiolani Medical Center For Women And Children. University of Hawaii. John A. Burns School of Medicine
↑ Page 82 in: Elizabeth D Agabegi; Agabegi, Steven S. (2008). Step-Up to Medicine (Step-Up Series) . Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 978-0-7817-7153-5.
1 2 3 Staheli, Lynn, Practice of Pediatric Orthopedics p. 274.
1 2 3 4 Staheli, Lynn, Practice of Pediatric Orthopedics p. 272.
1 2 3 Staheli, Lynn, Practice of Pediatric Orthopedics, p. 258.
↑ Hilt, Nancy E, Pediatric Orthopedic Nursing p. 12.
↑ Staheli, Lynn, Practice of Pediatric Orthopedics p. 260.
1 2 3 4 Staheli, Lynn, Practice of Pediatric Orthopedics p. 257.
1 2 3 4 5 6 "Growth Plate Fractures". orthoinfo.aaos.org, by the American Academy of Orthopaedic Surgeons . Retrieved 2018-02-05. Last Reviewed: October 2014