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Fractures

What are fractures?

Fractures are cracks or breaks in bones.

Because children are flexible, their bones may bend after a break, but often straighten out as they heal. This process is called remodeling.

Because of remodeling, a child’s broken bone will heal better — with less treatment — than a similar fracture in an adult. On the other hand, some fractures that look simple to treat can cause serious problems and affect the bone’s ability to grow.

In every child’s bones, growth occurs at specific points called growth centers or growth plates. Often, these points are near the ends of the bone. If the growth plate is damaged by a fracture or another injury, the bone may stop growing.

This serious problem is called a growth arrest. Growth arrest can permanently stop a bone’s development and change how it functions.

Types of fractures

Simple fractures

Simple fractures are breaks or cracks in the bone that do not break through the skin.

Open fractures

Soft tissue swelling.
Soft tissue swelling.

Open fractures are breaks in which the bone sticks through the skin.

Trauma fractures

Most fractures occur due to injury, such as falling while running, pedaling a bicycle or riding a skateboard.

These types of injures happen to healthy children with healthy bones. The bone gets more force than it is able to handle and breaks.

Stress fractures

These fractures can happen when a child repeats the same position or motion over and over for long periods of time.

Both-bone forearm fracture.
Both-bone forearm fracture.

Pathologic fractures

This type of fracture occurs because the bone is weaker than normal. A pathologic fracture is usually due to holes in the bone (bone cysts) or certain bone conditions, such as brittle bone disorder (osteogenesis imperfecta).

Brittle bone disorder is an inherited (genetic) condition where bones break easily for little apparent reason.

How do you evaluate fractures?

When your child breaks a bone, he will have pain at the site of the break. It will be hard for him to move the body part that is broken. This pain and loss of movement is your cue to take him to his doctor or the emergency room.

At Children’s Hospital, we will examine your child and take X-rays of the affected bone or bones. This helps us know how to treat your child.

Simpler breaks can be treated with a sling or a cast. More complex breaks may require surgery. Knowing when a child’s fracture needs surgery requires special education and experience with pediatric trauma.

Who gets fractures?

Trauma fractures are very common in children. About half of all boys and a quarter of all girls break a bone sometime during childhood.

Stress and pathologic fractures are much less common. Children usually develop stress fractures as the result of overuse, such as prolonged running or after an increase in activity.

What is your experience with fractures?

At Children’s, we understand children’s growing bones. We have the knowledge and experience to provide expert fracture care, including surgical treatment of the most complex cases.

We treat more than 1,000 children with fractures each year. In the summer, when children play the hardest, we see 10 children with fractures on our busiest days. Many of the children we treat are referred to us from other doctors and hospitals throughout the Pacific Northwest.

How do you treat fractures?

Flexible rod stabilization.
Flexible rod stabilization.

Our fracture team is led by surgeons who specialize in the treatment of bones, muscles and joints (orthopedists). The team also includes physician assistants, orthopedic technologists, nurses and pediatricians trained in sports medicine.

If your child’s X-ray shows a fracture, but the bone is straight and in a good position, we may give him a splint or sling to keep the bone in place while it heals.

Sometimes this splint or sling is all that your child needs while the bone heals. Depending on which bone he has broken and the severity of the break, we may need to put a cast on once swelling is under control.

We apply casts if we think the bone may not heal correctly unless it stays securely in one position.

We also use casts if they can make your child more comfortable by keeping his broken bone still, which reduces the pain that comes if the broken body part is bumped or moved.

Surgery for fractures

If your child’s X-ray shows that the broken bone is at an angle and in a bad position, we may need to do a surgical procedure called a fracture reduction. In this operation, we usually are able to bend the fracture into a better position.

If that is not successful, we will make an incision so we can see the fracture and reduce it (open reduction). In some cases, we use surgical screws and other devices to keep the bone in place so it can heal correctly.

About 20% of the children we treat for broken bones need surgery. If your child does need an operation, our surgical staff can ensure that he receives the most appropriate surgery for his injury.