Fracture

Fracture

There are different types of fractures. Your child's treatment will depend on the type of fracture, and where it is.

Key points to remember

  • a fracture is a break in the bone
  • there are different types of fractures
  • your child's treatment will depend on the type of fracture, and where it is
  • make sure your child goes to all follow-up appointments with your doctor - often further x-rays are necessary to check healing and bone position
  • how long it takes for your child's fracture to heal depends on where the fracture is and how severe the break is

Most children with simple fractures can have their treatment in the emergency department and go home from there.

What is a fracture?

A fracture is a break in the bone. There are many different types and names of fractures.

Closed fracture

There is a break in the bone but no damage to the skin or tissue.

Open or compound fracture

There is a break in the bone and damage to the skin or tissues near the fracture. Having damage to the skin means there is a risk of bacteria getting into the bone. This can cause a bone infection.

Greenstick or buckle fracture

This is a common injury in children because a child's bone can bend or buckle more easily than an adult's, without completely breaking.

How is it diagnosed?

Your child will need an x-ray to see where the fracture is, what type of fracture it is and whether or not the bones are in line. 

What is the treatment?

First aid

Keep the injured arm or leg still. Someone who knows how to might use a splint to keep it still.

You can support the injured arm or leg with a pillow or sling.

Raise the arm or leg higher than the heart to help reduce swelling.

Your child will need pain relief. If your child is in a lot of pain, call an ambulance. 

Fracture treatment

Different fractures need different treatments.

Usually, the treatment for fractures in children is a plaster cast. Sometimes, after a fracture, there can be swelling so your child may need a splint (half a cast) for the first few days. When the swelling goes down, a nurse or doctor will put a carefully shaped plaster cast on to hold the bones in the correct position.  

If your child has a fracture where the bone ends are not lined up (displaced), a doctor or nurse may need to move the bones into a better position before putting on the plaster cast. This is called manipulation and your child will need sedation or a general anaesthetic.

Sometimes your child will need an operation to fix the fracture with screws, nails, plates or wires. This surgery is called an ORIF (open reduction and internal fixation). Your child will need a general anaesthetic. This surgery may be necessary for fractures:

  • into a joint - an articular fracture
  • involving a growth plate (the cartilage or connective tissue at the ends of long bones in growing children) - this is called an epiphyseal fracture
  • through abnormal bone - a pathologic fracture
  • where there is significant displacement and the bones can't be lined up (reduced) or won't stay lined up after manipulation
  • where there is damage to the skin - an open fracture

Sometimes, your child will need traction to keep the bone in position. This involves the use of pulleys, weights and bed rest. 

Your child's doctor will discuss with you what treatment is necessary for your child's fracture.

Will my child have to stay in hospital?

The time your child is in hospital will depend on:

  • the bone(s) involved
  • the type of fracture
  • the treatment they need
  • the need for pain relief
  • how much swelling your child has

Most children with simple fractures can have their treatment in the emergency department and go home from there.

If the fracture is more severe, the orthopaedic team (bone specialists) will keep your child in hospital to watch the swelling, keep the arm or leg raised and give your child stronger pain relief if they need it.

How long will it take for the fracture to heal?

Children heal differently. Your child's healing depends on where the fracture is and how severe the break is. For example, a simple buckle fracture will need a plaster cast for 2 to 3 weeks and be almost completely healed in 4 weeks. Children heal in about half the time it takes an adult to heal from a similar injury. Often fractures in bones that are growing will correct their own shape ('remodel'). This means that even if your child's bones are not quite in line, they will usually correct themselves with time.

How can I care for my child at home?

In the first few days, your child may have swelling and pain in their fractured limb. To reduce the swelling and discomfort when your child is resting, raise the limb by resting it on a pillow.

If your child has a fractured arm, they should wear an arm sling when they are up and about.

If your child has a fractured leg, they will need crutches. Remember that in the first few days, your child should rest and keep their leg raised. They should only use crutches for short periods such as getting up to go to the toilet. Follow the instructions of the medical team about when your child stands or walks. 

Your child will usually need pain relief for the first few days after going home from hospital. Your child's nurse or doctor should talk to you about pain relief before you go home.

You should ask your child's doctor when it is OK for your child to return to normal activities such as school and sport.

When should I seek help?

After going home, you should take your child back to the emergency department or contact your medical team urgently if your child:

  • complains of pain that is getting worse even with pain relief and raising the fractured arm or leg  
  • has a hand or foot that is going cold, pale or blue or becoming more swollen
  • complains of fuzziness, numbness, pins and needles or tingling in the fractured arm or leg or in their toes or fingers
  • cannot move their toes or fingers

If your child's plaster becomes cracked, broken, soft or loose, or it is rubbing, contact your medical team. If it is a leg plaster, your child shouldn't walk on it and should use crutches.

What follow-up is required?

It is very important that your child goes to all their follow-up appointments.

Your child will usually have a fracture clinic appointment 5 to 14 days after leaving hospital. At this appointment, your child will have another x-ray to make sure the bone is healing and is in place. Your child will usually need to go to several more appointments at fracture clinic to make sure the break is healing.

Ask your nurse or doctor for instructions for your child's follow-up before you leave hospital.

Starship Foundation and the Paediatric Society of New Zealand acknowledge the cooperation of Starship Children's Health, Auckland District Health Board.  The content on this page was produced in collaboration with the Starship Orthopaedic Service.

This page last reviewed 21 November 2017.
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