Paediatric Fractures
What are paediatric fractures or children’s fractures?
Children and adolescents often suffer injuries or fractures that require non operative treatment such as removable and waterproof casts or splints. Our Fracture Clinic staff provide expert fracture management for children, with early rehab, waterproof casts and optimal care plans.
If your child has suffered a limb injury that requires prompt medical attention but is not an emergency, we can provide the care they need with our 6 week post-injury management plan.
Children’s bones have excellent remodelling potential, often straightening over months with growth. This unique characteristic frequently allows non-operative paediatric fracture management where surgery would be required in adults.
Follow-up care depends on fracture type and local circumstances, potentially including fracture clinic visits, replacement of plastering and/or application of a waterproof cast, virtual consultations, plus private paediatric orthopaedic surgeon review, where appropriate, or general practice follow-up – until the patient’s normal range of motion is restored.
Common Paediatric fractures
- collarbone or shoulder
- arm and elbow
- forearm, wrist, or hand
- hip
- thigh bone or knee
- leg, foot, or ankle
Non-displaced fractures
- Single non-displaced: bone breaks but stays aligned
- Stress (hairline): tiny cracks from overuse
- Torus/buckle: bone bends upon itself – common in Children
With non-displaced fractures, the bone typically stays aligned in an acceptable position for healing. Such fractures are usually treated with a splint, brace, or cast. This immobilizes the injured bone, promotes healing, and reduces pain and swelling.
In a greenstick fracture, one side of the bone bends (buckles) upon itself. The bone is dented but not broken. This is a common childhood injury that typically results from a simple fall.
Stress or hairline fractures are tiny cracks form in the bone, usually as a result of overuse or repetitive stress-bearing motions. Stress fractures are common in children who run track or participate in gymnastics or dance. These can be painful.
Displaced fractures
- Angulated: broken ends at an angle
- Translated: ends shifted out of alignment
- Rotated: bone spun during break
- Greenstick: one side broken, with some parts of the bone still attached or bent
When a fracture is displaced, the ends of the bone have come out of alignment. In such cases, the broken bone needs to be set back into alignment so it will heal properly. This is called a reduction. After the reduction, the injured limb is immobilized with a brace, splint, or cast while the bone heals. If the reduction is unsuccessful, other treatment may be necessary. Luckily, children’s fractures have a great potential to “remodel” after healing and often correct themselves over time as the child grows.
Severe fractures
- Comminuted: multiple pieces
- Compression: bone collapse under pressure
- Growth plate fractures
- Open (compound) fractures: bone penetrates skin
Bone fractures are classified as either open or closed. A closed fracture occurs when the bone is broken, but the skin remains intact. An open fracture, also known as a compound fracture, occurs when the broken bone breaks through the skin. Open fractures are not common and require surgery in hospital as they can become infected if not treated appropriately with a surgical washout.
Growth plate fractures
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Growth plate fractures are typically caused by great force during sports or playground accidents. Depending on the seriousness of the fracture, they may be treated with a splint, cast, or walking boot. Some serious growth plate fractures require surgery.
In rare cases, growth plate fractures can slow the growth of the affected leg or arm. Damage to a growth plate can also cause the limb to grow at a wrong angle. When surgeons operate on broken limbs in children, they must protect the growth plates as much as possible.
Common Causes of Paediatric Fractures
- sporting accidents
- falls from heights
- bike and car accidents
- poor nutrition
- low calcium diet
- obesity
Signs and symptoms of Paediatric Fractures
- pain or swelling in the injured limb
- obvious deformity
- difficulty using or moving the affected area
- warmth, bruising or redness
Immediate medical attention is required if symptoms are present. For compound fractures (bone visible through broken skin), keep the child still and call an ambulance.
How are fractures diagnosed?
A Fracture Clinic specialist will closely examine the injured area for tenderness, redness, and swelling and will order diagnostic imaging tests to determine what type of treatment is appropriate. Diagnostic testing for fractures may include:
- X-Ray
- Computed Tomography scan (CT, CAT scan) shows great detail not visible on x-rays.
- Magnetic Resonance Imaging (MRI) is needed to detect fractures (such as stress fractures) that don’t show up on an X-ray until after the bone starts hurting. An MRI can pick up smaller fractures before they get worse.
- Bone scan
What are the treatments for a child’s fractured bone?
Treatment will be based on the type of fracture, its severity, and your child’s age. In most cases, fractures in children are treated with a sling, splint/brace, cast, or walking boot. These immobilise the injured bone while it heals.
Treatment options:
- Splints/split casts: used initially for swelling
- Boots and casts: stabilise fractures
- Reduction: non-surgical realignment that is usually performed in an emergency department or operating theatre with medications that manage pain and make your child sleepy or sedated so they won’t remember the procedure.
- Surgery: for severe or unstable fractures that are unlikely to “remodel” themselves or can’t be set properly with a gentle reduction may require surgery. We refer children requiring surgery to an Orthopaedic Surgeon of your choice or to the public system if that is preferred. To increase the chances that the bone will heal in the correct position, your child’s doctor will decide very early in treatment whether surgery is likely to be required.
How are fractures diagnosed?
After the splint, cast or walking boot is applied in the first 24 hours, regular and careful monitoring and patient (and parent) education become crucial to ensure proper healing, to regain early recovery of function and to avoid complications for the next six weeks.
Commonly, the problems we see at the Fracture Clinic are with immobilisation appliances that fail to immobilise! Worse, casts can become:
- Loose
- Dirty
- Wet
In the first two weeks, parents of children with casts should look for:
- Signs of skin irritation or breakdown
- Unusual swelling or discoloration of the limb
- Increased pain or discomfort
- Fingers or toes becoming pale, blue, or cold (indicating potential circulatory issues)
- Any loosening or damage to the cast
- Presence of foul odor or drainage through the cast
If attending the Fracture Clinic, our approach is to meet your child, check on their health and review the immobilisation device. We can either replace or leave the current device in place if it is providing sufficient support and is comfortable. During the assessment, we will:
- Assess the child’s pain levels
- Evaluate the healing process
- Check the integrity of the cast or splint
- Ensure proper alignment and positioning (with an XRay)
- Discuss any concerns or questions with the patient and parents
- Commence rehabilitation or regain of function exercises, when appropriate (depending on the results of the above).
This approach helps optimal healing and early detection of any potential complications during the fracture recovery process. Our staff are experienced musculoskeletal practitioners that include advanced practice physiotherapists, nurse practitioners, sports doctors and/or orthopedic surgeons.
How can I book an appointment at the Fracture Clinic?
You can call their phone number or make an appointment online via their website. The clinic is open from 8 a.m. to 4 p.m., Monday through Friday.
Does the Fracture Clinic accept insurance?
The goal of the Medicare-funded Fracture Clinic is to offer patients high-quality care at comparatively cheap out-of-pocket expenses. It’s best to get in touch with the clinic directly if you have particular insurance questions.
