Broken Bones: Not All It’s Cracked Up to Be
Musculoskeletal injuries are a major reason for pediatric emergency department visits each year, comprising approximately 12 percent of total visits. Children are prone to fractures because growing bones have not reached adult strength, and children are generally very active.
An additional concern related to childhood fractures is that the weakest part of children’s bones is at the growth plates, located on each end of long bones of the arms and legs. If the growth plates are injured and do not heal correctly, the affected limb can have trouble growing or may grow at an incorrect angle. However, a young bone’s propensity for continued growth contributes to children’s incredibly fast rate of healing.
If you suspect a broken bone after an injury, the first thing to do is to keep your child from moving the affected extremity. Although this is easier said than done, especially with very active children, it is very important to avoid excess movement, which can worsen a fracture. You can try using objects around the house to accomplish this task.
For a shoulder or arm, you can use make a homemade sling out of a piece of cloth. A leg injury can be stabilized with padded boards or pillows wrapped around the leg. Avoiding applying weight to the affected extremity is also important, therefore you might have to carry your child until he or she can be seen by a doctor. Depending on the severity of the injury, drive your child to the primary care physician’s office, urgent care or emergency room. Concerning signs for fracture include tenderness over the bone itself, bones that look out of place, or the inability to tolerating walking if the affected limb is a leg.
A physical exam focusing on the affected limb allows the provider to investigate the possibility of a fracture, and compare the affected limb to the unaffected side to assess for any differences. The management of broken bones depends on the location, but generally involves keeping the affected bone immobile while it heals. A broken bone may need surgery, but this is not always the case. The amount of time that casting is required depends on the injury, but varies from no casting at all to up to eight weeks.
If no fracture is discovered, then your child will likely be diagnosed with a muscle strain or sprain. The treatment for muscle strains and sprains is illustrated with the acronym "RICE", which stands for rest (limited activity), ice (cold packs to affected area), compression (ACE bandage for support and to decrease swelling), and elevation (raising up the affected area to help decrease swelling). Whatever the injury, nearly all children with broken bones recover fully.
Dr. Joel Gallagher is a pediatric resident at Levine Children’s Hospital at Carolinas Medical Center, and Dr. Shivani Mehta is a board-certified pediatrician at CHS Myers Park Pediatrics.