When a child breaks a bone, it may raise many concerns and questions for caregivers.
Lurie Children’s nationally ranked Lurie Children’s Division of Orthopaedic Surgery and Sports Medicine experts care for more than 41,000 children every year, providing a range of services for children with orthopedic disorders and conditions, including bone fractures.
Learn more about the division or how to make an appointment at LurieChildrens.org/Ortho.
Fractures are less common in babies compared to older children. When a child begins to walk and climb, they are more likely to fall and break a bone.
The wrist (distal radius) is the most common fracture we see in children, followed by fractures of the elbow and forearm. The tibia (shin bone) is the most common long bone fracture site in the lower extremity.
The type of fracture can vary. Incomplete fractures, often called buckle fractures, are common in children. These include what we call hairline, torus or greenstick fractures. Bone is covered by a tissue called periosteum, which is thicker and stronger in children than in adults. Children’s bones are also “softer” (osteoporotic) and more bendable than adult bones. With this thick periosteum and softer bone, the child’s bone will bend before it completely breaks, often resulting in these types of incomplete fractures.
We see fractures in children from all types of sports and activities. Anything with wheels (bikes, scooters, skateboards, rollerblades) to playground equipment (swings, monkey bars) to trampolines can increase the risk of a fall and injury.
The higher and faster a child goes, the greater chance of an injury if they fall. You cannot prevent all fractures, but you can reduce with risks of an injury with proper precautions and the right protective equipment, such as wrist guards and helmets.
You cannot always tell a sprain from a fracture on physical examination. That is why we get an X-ray if we are unsure. In general, the ligaments will hurt more on direct palpation than the bone if there is a sprain and the opposite is true for a fracture. Both can have significant swelling and bruising.
If there is obvious deformity of the limb, go to an emergency room.
If the pain is severe, then immediate attention is needed in an emergency room or an immediate care center where X-rays can be obtained.
If there is no deformity and only mild to moderate pain, you can wait and watch to see how the child does over time. If the pain persists or the child refuses to use the limb you can seek medical care the following day with a pediatric orthopedist or an immediate care clinic that can get X-rays.
In general, children’s fractures heal quicker than adults due in part to the tissue that surrounds the bone called periosteum, which is thicker and stronger in children than in adults.
Children’s fractures may heal with some angulation, but can grow straighter. Adults with fractures will not do this.
Still, children have growth plates which are responsible for bone growth, and the growth plate may be involved in a child’s fracture. This can result in problems with growth long after the fracture heals. Therefore, fractures involving growth plates must be followed for a minimum of two years after healing to watch for problems. These can be monitored by doing X-rays.
Most children’s fractures are treated non-surgically. Cast, braces, and walking boots are the most common ways to treat these fractures. Fractures involving the growth plates or the joints are more likely to need surgery.
Many minor fractures are treated with a removable brace or walking boot and not a cast
Pediatric orthopedic surgeons are specifically trained to care for children’s injuries. Treatment is often different than those for adults with the same injury. Frequently specialized instruments are required for the child and many adult orthopedic surgeons are not familiar with these instruments and the techniques in using them. Care of a growth plate injury is often out of the realm of care provided by the adult orthopedic surgeon.
Beyond the skills and knowledge that pediatric orthopaedic surgeons bring to the care of children’s unique injuries, their experience in caring for young people and their families, with sensitivity to their special needs, may contribute extra value to the therapeutic interaction.