Fractures are common in children, and as many as 1 in 3 children sustain fractures in their lifetime. Children and adolescents have growing tissue near each end of the bones in their arms and legs. Called growth plates, they determine the length and shape of their bones as they grow up. In adolescence, when growth is complete, these growth plates close up and are replaced by solid, mature bone.
Children are more prone to fractures rather than ligament sprains as their bones and growth plates are weaker than their ligaments.
Generally, the younger the child, and the closer the fracture is to the growth plate, the better chance there is for a fracture to heal.
Most common paediatric fractures and injuries
The 3 most common fractures in children occur in the wrist, elbow and ankle.
1. Wrist Fractures
Wrist fractures are the most common fractures in children. They typically happen when a child stretches out their hand to break a fall.
Symptoms of a fractured wrist in children include pain, swelling and at times, deformity at the wrist. X-ray scans are used to assess the type of fracture sustained and if the growth plate is affected. The most common type of growth plate injury is a buckle fracture, where one side of the bone bends but does not break all the way through.
Wrist fractures tend to heal well and can be treated with a cast for approximately 2 – 3 weeks.
In cases where the bones are misaligned or the child is older (10 – 15 years), surgery may be needed to realign the bones and prevent deformity.
2. Elbow Fractures
Elbow fractures are another common childhood injury and the most common of these is the Supracondylar Humerus Fracture. It is an injury to the upper arm bone at its narrowest point, slightly above the elbow.
It tends to occur in children, between 5 – 7 years old, when they fall down onto an outstretched hand. This overloads the elbow, causing a fracture, and can sometimes occur together with a wrist injury as well.
Symptoms of elbow fractures include swelling around the elbow, inability to straighten the arm, numbness in the hand due to a possible nerve injury, and intense pain in the elbow and forearm. X-ray scans are used to determine the type and location of fracture.
In the case of mild fractures where bones are not displaced, treatment consists of using a cast or splint for about a month for the fracture to heal.
Where the fracture is more serious or where bones are displaced, surgery would be required to realign the bones and hold them in place with metal pins for healing to happen. The pins are removed a few weeks after surgery, once healing begins.
3. Ankle Fractures
Ankle fractures affect children of different age groups differently. Fractures involving the growth plate are classified according to the Salter-Harris (SH) classification system, which show the different types of fractures and treatment required.
Symptoms of ankle fractures include not being able to rest weight on the ankle, tenderness and swelling around the ankle and possible bone deformity or displacement.
Salter-Harris Type 1 Fractures
In type 1 fractures, the fracture cuts through the growth plate and separates the bone end from the bone shaft. About 5% of fractures are type 1 fractures.
Younger children tend to incur type 1 fractures. On x-ray scans, there may be no obvious deformities seen.
Treatment for these fractures usually does not require surgery and consists of using a cast to allow it to heal in place.
Salter-Harris Type 2 Fractures
Type 2 fractures are the most common type of ankle injury, making up about 75% of fractures. This fracture cuts through the growth plate and cracks through a part of the bone shaft as well.
Treatment for these fractures usually does not require surgery and consists of using a cast to allow it to heal in place. In some cases, a procedure called Closed Reduction may be required. This is a non-surgical procedure where the doctor sets the bones in position by pushing or pulling the bone. Your child will be put under anaesthesia for this procedure.
Salter-Harris Type 3 and 4 Fractures
Type 3 fractures damage the growth plate as well as the joint. They typically affect children above the age of 10 years old, when ankle fractures become more difficult to treat as the child enters adolescence.
Type 4 fractures damage both the growth plate and the bone shaft, breaking through the end of the bone as well.
Type 3 and 4 fractures make up about 10% of fractures each.
X-ray or Computerised Tomography (CT) scans are used to diagnose these fractures.
Treatment focuses on ensuring there is joint congruity through casting or closed reduction. It is important to restore joint congruity as it may otherwise lead to arthritis developing in the future.
If there is still significant bone displacement after closed reduction is done, surgery will be required to better align the broken bone, with screws and pins being used to fix the broken pieces in place.
Seek treatment early for childhood fractures
Fractures and injuries in children are a cause for concern. Children’s bones are unlike adult bones as the bone composition and strength are different, and are more likely to injure first before the ligaments and tendons. Most importantly, our children’s bones are still growing. Fractures and injuries to the bone must be treated early as they can disrupt bone growth and lead to deformity.
When in doubt, please seek the advice of a doctor, preferably in the Accident & Emergency (A&E) department, or a paediatric orthopaedic specialist. Your doctor will be able to address your concerns, accurately diagnose the injury and its extent and provide a treatment plan.
While most children will be doing home-based-learning during this circuit breaker, parents should note that children can also take a tumble in enclosed spaces. Should such incidents occur, parents should not hesitate to seek treatment urgently.
Article reviewed by Dr Tay Guan Tzu, orthopaedic surgeon at Parkway East Hospital
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