Pediatric Fractures
Pediatric Forearm Fractures
The radius (bone on the thumb side) and ulna (bone on the little-finger side) are the two bones of the forearm. Forearm fractures can occur near the wrist, near the elbow or in the middle of the forearm. Apart from this, the bones in children are prone to a unique injury known as a growth plate fracture. The growth plate, which is made of cartilage (flexible tissue) is present at the ends of the bones in children and helps in the determination of length and shape of the mature bone.
The healing of fractures in children is quicker than that in adults. Thus, if a fracture is suspected in a child, it is necessary to seek immediate medical attention for proper alignment of the bones.
What are the different types of forearm fractures?
Forearm bones may break in many ways. Fractures may be “open” where the bone protrudes through the skin, or “closed” where the broken bone does not pierce the skin. The common types of fractures in children include:
• A stable fracture that compresses the bone on one side, forming a buckle on the opposite side of the bone, without breaking the bone (Buckle or torus fracture)
• One side of the bone breaks and bends the bone on the other side (Greenstick fracture)
• Displacement of the radius, and dislocation of the ulna at the wrist where both bones meet (Galeazzi fracture)
• Fracture affecting the upper or lower portion of the bone shaft (Metaphyseal fracture)
• Fractured ulna and dislocated head of the radius (Monteggia fracture)
• Fracture occurring at or across the growth plate (Growth plate fracture)
What are the causes of forearm fractures?
Forearm fractures in children are caused due to a fall on an outstretched arm or direct hit on the forearm, which may result in breakage of one or both bones (radius and ulna).
What are the symptoms of forearm fractures?
A fractured forearm causes severe pain and numbness. Other signs and symptoms include:
• Swelling
• Tenderness
• Inability to turn or rotate the forearm
• Deformed forearm, wrist or elbow
• Bruising or discoloration of the skin
• Popping or snapping sound during the injury
How are forearm fractures diagnosed?
Forearm fractures in children can be diagnosed by analyzing X-ray images of the wrist, elbow or the forearm.
What are the treatment options?
The treatment of forearm fractures in children is based on the location, type of fracture, degree of bone displacement and its severity.
Non-surgical therapy
Your child’s doctor will advise you to apply an ice pack over a thin towel on the affected area for 15-20 minutes 3-4 times a day, to relieve pain and swelling. For severe angled fractures, in which the bones have not broken through the skin, your doctor will align the bones properly without the need for surgery (closed reduction). A splint or cast may be required for 3 to 4 weeks for a stable buckle fracture. Immobilization for 6 to 10 weeks is recommended for more serious fractures.
Surgical Treatment
Surgery may be necessary for severe fractures such as fractures of the growth plate or the joint. Other conditions, such as broken skin, bone displacement, unstable fractures, misaligned bones, and bones healing in an improper position may also require surgical repair. Your surgeon will first align the bones through an incision and use fixation devices like pins or metal implants to hold the bones in place while the wound heals. A cast or a splint may be placed to hold the bones in place.
Conclusion
In the long run, the forearm of your child may have a slightly different or crooked look than before the fracture, which is normal. It may take around 1-2 years for the bones of the forearm to straighten while the bones undergo the process of remodeling (reshaping). For growth plate fractures, your child’s doctor will carefully monitor the hand for many years to ensure that growth occurs normally.
Pediatric Thighbone (Femur) Fracture
The femur or thighbone is the largest and strongest bone in the human body. Pediatric thighbone fractures can occur when your child falls hard on the ground, and gets hit during sports, automobile accidents and child abuse. In a thighbone fracture, the broken bones may be aligned or displaced. The fracture can either be closed (with skin intact) or open (with the bone piercing out through the skin). Your child may experience severe pain, swelling, inability to stand and walk, and limited range-of-motion of the hip or knee.
Your child’s doctor will conduct a physical examination. An X-ray or CT scan may be recommended to locate the position and number of fractures, and determine if the growth plate is damaged. Femur fractures may be treated with nonsurgical or surgical methods.
Nonsurgical treatment involves stabilizing the bones so they can heal and fuse together. Braces, spica casting (cast applied from the chest, down the fractured leg) or traction (placing the leg in a weight system) may be applied to ensure that the bones are properly set in their normal position.
Surgery is recommended for complicated injuries. Your child’s surgeon aligns the broken bones and uses metal plates and screws to hold the fractured bones together in proper alignment. Your child may have to wear a cast for a few weeks until complete healing. An external fixator may be used in case of open injury to the skin and muscles.
