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WHAT  IS  A  FRACTURE?

 

A fracture is a crack or break in a bone. Fractures can be serious, with the bone broken in several places or pushing through the skin. This is known as a compound fracture, and can be complicated by injury to adjoining nerves, muscles and blood vessels.

 

However, children's bones are so flexible and resilient that fractures are not usually that serious. Often, children's bones do not snap like an adult's, but bow or break the outer lining of the bone only, rather like new wood. Such breaks are called greenstick fractures. Complications, such as infection or failed healing, are much less common than with adults, and children's bones heal a lot quicker.

 

Signs of a fracture

 

A toddler may be unable to communicate where he is hurting, so it is possible for parents to be unaware of a fracture look out for the following signs:

 

• Swelling or bruising of a limb. (A toddler's healthy chubbiness at this age may mask any obvious outward signs of a fracture).
• Limping or refusing to walk.
• Not using an arm or leaving the arm hanging by his side as if it is paralyzed.
• Crying whenever the limb is used or touched. 

What to do for a suspected fracture

 

Basic first aid is to support the broken bone - for example, strap a wounded finger to the finger next to it. However, this may cause further upset and pain.

 

The best thing to do is to take your child to an accident and emergency department or doctor's surgery as quickly as you can. Certain bones, such as the thigh bone (femur) and pelvis, can bleed profusely internally - any suspicion of such a fracture should be treated as an emergency. 

Don't let your child have anything to eat or drink until he has seen a doctor because he might need a general anaesthetic. 

After treatment, the doctor may give your child liquid paracetamol. This should help to ease the pain.

 

With their boundless energy, insatiable curiosity, early unsteadiness and total lack of any sense of danger, toddlers and young children are susceptible to fractures. 

 

How  are  fractures  treated?

 

Deciding on the best way to treat a fracture is often straightforward and a casualty doctor makes the decision.

 

Splint: plaster of Paris is used most commonly. Initially, a half plaster is put on because of the swelling around the fracture. Once the swelling has reduced, a full plaster will probably be put on.

 

Manipulation: the broken bone is pulled back into line and then plastered, under a general anaesthetic

External fixation: pins are inserted into the bone through the skin, and then fixed to hold the bones in place while they heal

 

Traction: for a bone that is badly out of line, the best way to ensure proper healing is to fix the limb, usually a leg, using a traction system, with the child bed bound.

 

Surgery: if the fracture is too great to heal naturally, the surgeon will fix the two broken ends, using temporary metal plates and pins

 

How does bone heal

 

Fractures are like any other wound - if they are not protected, they will not heal properly. However, most bones will have healed in four to six weeks in the toddler age group. A broken bone goes through several stages as it heals:

 

Initially, There is bleeding with swelling and pain around the fracture. Cells calls osteoclasts get red of the old dead bone. 

After a few days, chondroblast cells form new bone called soft callus. Callus is made of blood vessels, fibrous tissue, cartilage and bone. 

Hard callus appears after two to three weeks. This may form a lump that can be felt under the skin. On an x-ray the fracture line will no longer be visible, but a cloud of new bone will have appeared around the fracture site. 

Remodelling is the final stage of healing. If the bone has healed out of shape, it is now restored to its original shape. This remodeling takes around three months for toddlers, while it may take several years for older children and adults. 

The above X-ray of a broken arm in plaster has been taken to assess how well the fracture is healing. The plaster cast protects the broken bone, preventing movement of the aligned ends until healing has progressed sufficiently.

 

Learning to walk

 

When toddlers are learning to walk, they may fall in such a way as to cause a particular type of fracture.

 

Toddlers will often keep one leg still when they fall, while the other twists underneath them. This twisting leads to a spiral-shaped fracture of the tibia, one of the two bones in the lower leg. A fracture of this kind can sometimes be missed because it's difficult to see on an X-ray.

 

Your child's mobility will be checked by your health visitor at the developmental checks. 

 

When your child is in plaster

 

Check his circulation and make sure that he doesn't develop an infection. Seek medical advice if you think there is a problem. look out for the following signs:

 

• Toes (or arms) turn blue or white, are cold and not moving, or are swollen.
• There is redness, swelling or pus.
• Your child has a fever and/or is in pain, having been settled beforehand.
• The plaster seems soggy,
• Broken or loose. 

Long-term effects

 

Most fractures heal and cause no further problems. However, a fracture that involves a child's growth plate may have a lasting result.

• The growth plates (epiphyses) lie at each end of the long bones, and those most commonly affected are located in the fingers and the wrist. 
• Any interference with these, such as a break, may stop the bone growing. The fractured bone may therefore be shorter than it would have been with normal development. 
• This kind of fracture will be monitored closely by the orthopaedic doctors to ensure that growth is not affected. 

A child's hand, wrist, ankle and foot bones develop gradually in the first four to five years. In normal growth, a one-year-old child has three wrist bones, with the remaining six developing during early childhood.

 

For  More  Information:  Please  consult  your  physician  on  your  next  visit.