There’s a saying that children are not merely small adults, and the same can be said about their fractures. Fractures in children are different from adults. Children have growth plates in their bones, which are areas at the ends of long bones where the bone increases its length as the child grows. With this growth potential, it is possible for certain healed fractures to re-model as the child grows older. Hence, some paediatric fractures which have initially healed with a mild deformity can re-model to become normal again as the child grows.
However, it is also this growth potential that any injury that affects the growth plate in one bone may affect the growth of the affected bone, and result in asymmetry in the limbs, which can be particularly problematic for lower limbs due to the resulting shortening of one leg compared to the other.
Some common paediatric fractures are described here.
Supracondylar fracture of the elbow
A supracondylar fracture of the elbow is one of the most common childhood fractures. It typically affects children between the ages of 5-7. It is a common playground injury and frequently the child sustains the injury from a fall on the elbow as the fall from monkey bars or other equipment. It is important to see an orthopaedic doctor after this injury can result in nerve damage and impaired circulation.
Treatment may be possible using an elbow cast in some cases, but in cases where the fracture is badly displaced, surgical fixation may be required.
Forearm (Radius and ulna) fractures
A fracture of the radius or ulna in the forearm usually results from a fall on the outstretched hand. It can vary from a growth plate injury, which happens at the lower end of the forearm, to a shaft injury, which occurs in the middle of the forearm.
The radius bone together with the ulna bone moves in tandem and is involved in the movement of the elbow and wrist. Any deformity in the radius or ulna will impair movement in the elbow and wrist. Hence, paediatric fractures in the forearm may require surgery to allow the bone to heal in good alignment so as not to affect the function of the forearm. These fractures are fixed using intra-medullary nails. Non-displaced fractures may be treated with casting, usually for 4 to 6 weeks depending on the age of the patient and the severity of the fracture.
Ankle fractures are a result of a twisting injury at the ankle, usually in slightly older children while participating in sports. It can affect the tibia bone, the fibular bone, or both. There are growth plates at the ankle, and fractures of the ankle in children can involve the growth plate, causing growth impairment or growth arrest. This can result in unequal leg lengths after the injury, which will, in turn, impair the ability of the child to walk or run properly.
It is important to have a proper assessment of an ankle fracture. Surgery may be required to restore the joint alignment and prevent long-term deformities in the child.