Fractures are more common in children due to their activities as well as their bone properties. Fractures in children are unique since children are still growing and their bones have not reached maturity. Children are more prone to certain type of injuries due to their activity and open growth plates. Growth plates are areas of the bone that allow for growth of each bone to its adult size. Presence of growth plates requires specialized care of pediatric fractures by a pediatric orthopedic surgeon to make sure that any treatment does not jeopardize future growth.
Common Fracture in Children:
Since bones in children are more flexible, they may not fracture in the same manner as adult bone. They may mimic a green branch that when bent buckles causing an area of irregularity and weakness in the bone without separation. These fractures still require attention however, rarely require surgery.
Elbow fractures are the most common type of fractures that may require surgery in children. These fractures vary from injuries that are nondisplaced and only require casting to fractures that involve the elbow joint and require surgery. Radiographs are carefully reviewed and followed to make the right decision for every child. The top priority is to maintain function and prevent future deformity or limitations. Most children with elbow fractures return to full function after treatment.
Growth plate fractures:
Growth plates are areas of specialized cartilage at the ends of the long bones in growing children. They are also potential areas of weakness. Fractures through any bone can involve the growth plate and can potentially lead to problems in the future. Accurate diagnosis based on imaging, careful manipulations in the office or operating room and judicious use of surgery minimize the risk of future problems. Growth plate fractures around the wrist, elbow, shoulder and ankle rarely lead to problems in the future. Injuries across the growth plates around the knees and hips tend to be at higher risk of future growth problems. Due to the risk of future problems, we continue to follow growth plate injuries well after the fractures are healed to identify and treat any problems that may come up.
Having open growth plates also spells good news for children. Since their bones are growing, the body has the ability of correcting small amounts of deformity at the time of the injury. The younger the child, the higher the body’s ability to correct deformity from a fracture. This remodeling potential is unique to growing children and allows the vast majority of fractures to be treated without surgery in casts or braces. It also means that fractures that would normally require surgery in an adult, do not require surgery in a growing child. Your pediatric orthopedic specialist is specially trained to recognize which injuries can be treated in a cast and which injuries require surgery.
Surgery is reserved for fractures that are either too displaced for the body to be able to correct, or in situations where avoiding surgery would lead to future functional problems. Common examples of such situations are:
- Displaced elbow fractures
- Fractures that involve joints
- Fractures with a lot of initial displacement or angulation
- Unstable fractures
- Fractures associated with open wounds
- Fractures associated with injury to tendons, nerves or blood vessels
The type of surgery is based on the area involved and the type of injury. Some fractures only require manipulation under anesthesia with casting whereas others may require pinning or fixation with plates and screws. The type of surgery selected may be different from surgical options in adults to protect future growth potential.
Most fractures heal relatively quickly in children. This, as well as increased flexibility, leads to less stiffness and quicker return of function in children as compared to adults. Most children do not require supervised physical therapy after their fractures are healed.
Therapy and bracing may be prescribed to regain muscle strength, normal gait and for functional training prior to return to sports. We work closely with our pediatric physical therapists to ensure return to full activities.