Dear Dr. Johnson: My 4-year-old is a “daredevil” and constantly getting hurt. Fortunately just bumps and bruises at this point but how would I know if he broke a bone?
Dear Reader: Broken bones (also called fractures) are the fourth most common injury in children under age 6 — so pretty common. They can occur from various types of injuries but are most commonly associated with falls. Major or severe fractures in children are most commonly a result of car crashes. Fractures can occur from falls from high places but can also occur from more minor falls and landing wrong.
The types of fractures that occur in kids are different than fractures in adults because children’s bones are more flexible and still growing. One of the common types of fractures in kids are greenstick where the bone bends and only one side of the bone breaks. Torus fractures are another type of common fracture in children. In torus fractures, the bone is twisted or buckled and weakened. Children can also suffer from other types of fractures including those that go completely though the bone.
Because children’s bones are still growing, there are growth plates at the end of the bones from which new bone length comes. Fractures can involve these growth plates causing damage and resulting in the bone growing at an angle or slower than the other bones in the body. Therefore, fractures that affect the growth plate may need to be followed for 12-18 months after the injury as it can take awhile for abnormal growth to become apparent.
Fortunately, fractures in children do not usually require surgery. Their bones tend to heal rapidly and well. Usually all that is required for treatment is immobilization, which generally is done with a cast made of fiberglass or plaster. Sometimes, more minor fractures are placed in a removable splint. If there is a significant angle between the two sides of the fracture or the edges don’t align, a reduction to realign the bones may be needed. This is usually only done after the child is given pain medication, sedation medications and/or full general anesthesia.
So the answer to your question as to how you would know if your child has a fracture, is that you can’t always tell without getting an X-ray. The most obvious sign of a fracture would be visible deformity of bone. More subtle signs would be a young child refusing to walk or move an extremity for a period of time after an injury. Tenderness in one specific spot over a bone can be concerning for a fracture. Being able to move the arm or leg does not exclude the bone being fractured. If you suspect your child could have a fracture they should be examined by a doctor in the clinic, urgent care or emergency room depending on the time of day and severity of the injury.