A break in the normal structure of a bone.
Bone fractures most often result from an accidental injury, although they may be caused by repeated stress from such activities as walking, dancing, or marching, or by medical conditions that weaken the bones. They are commonly divided into two major types: closed fractures, in which the ends of the bones remain in place under the skin, and open fractures, in which they protrude through the skin. Children's fractures are often less severe than those of adults and heal more quickly because their bones are softer and more resilient. (It is possible for a child's bone to bend more than 45 degrees without breaking.) Cracks, hairline, and "greenstick" fractures, in which the bone splits on one side, are common. Other types of fractures include the buckle fracture, in which the bone has been compressed and part of it is raised or bulging; the complete fracture, in which the bone is broken into separate pieces; and the dislocation fracture, in which the bone is both broken and dislocated.
About three-fourths of all children's fractures occur in the upper extremities, often as a result of a fall onto an outstretched hand, elbow, or side of the shoulder. This type of fall can also break the clavicle, or collarbone, the bone most often fractured by children. Elbow fractures, which account for about 10% of all children's fractures, must be treated promptly to prevent possible deformity and nerve damage. The femur, or thighbone, is another common site for childhood fractures, often caused by falling from a height or by an automobile accident. Also common are fractures of the bones in the lower leg—the tibia, or shinbone, and the fibula—which can be caused by a seemingly minor impact, such as jumping off a chair. These fractures are usually more serious in older children than in toddlers, damaging nerves and blood vessels.
Like other types of head injuries, skull fractures are not uncommon among children. Because their skulls are still relatively flexible, infants and young children can tolerate brain swelling after a head injury better than older children and adults. However, prompt medical attention is crucial; an untreated head injury can result in mental retardation or seizures. A trauma that causes excessive force to the neck or back, such as a severe shaking or whiplash, can result in a neck or spinal fracture. These fractures are among the most serious childhood injuries because they can damage the spinal cord, resulting in paralysis.
The primary symptom of a fracture is pain at the site of the injury, usually accompanied by swelling, discoloration, and a limited range of motion and/or inability to bear weight in the affected area. There may be visible deformity of the bone and, in common fractures, bone ends may be visible through the skin. A child with a fracture may experience numbness or tingling in an affected extremity and may become pale. An infant or toddler with a fracture will become fussy and irritable. Signs of a neck or spinal fracture include neck or back pain, numbness or paralysis, and holding the head or neck at an odd angle.
When a fracture is suspected, the child should be taken to a hospital emergency room. The injured area should not be moved and should not bear any weight until the child is examined by a physician. A limb in which a fracture is suspected can be immobilized using a makeshift splint made from a pillow, folded newspaper, or other support. Elevating and applying ice to the injured area can alleviate pain by minimizing swelling. No food should be consumed in case general anesthesia is necessary to reset the bone. It is especially important not to move a child with a suspected skull, neck, or spinal fracture. If pain and swelling from an apparent sprain or other musculoskeletal injury fail to lessen within a day or two, the child should be examined for a possible fracture.
A fracture diagnosis is made or confirmed by x-ray examination. Treatment varies depending on the type of fracture, the affected bone, and the age of the child. Realignment of the bone, also called fracture reduction, is often unnecessary in children, and immobilization in a plaster or plastic cast is usually sufficient. A fractured long bone in an arm or leg commonly takes from six to 12 weeks to heal in an adult and less time in a child. Some fractures may require immobilization by traction, pins, wires, screws, or plates. There may be complications if the growth plate at the end of a long bone (in an arm or leg) is injured. Damage to the growth plate can halt normal development, shortening bones and resulting in deformity of bones and joints.
Parents can take steps to reduce the likelihood of childhood fractures by installing safety gates in the home and using car seats for children weighing up to 40 pounds (18 kg). Strollers, carriages, tricycles, and bicycles should be sturdy and well designed, and children should be trained in bicycle safety. Padded surfaces under jungle gyms and other playground structures can reduce the incidence of fractures in children, and protective helmets used for activities such as bicycling and rollerblading can protect against skull fractures.
Clayman, Charles B., ed. The Human Body: An Illustrated Guide to Its Structure, 1st American ed. New York: Dorling Kindersley, 1995.
Hall, Katy. Skeleton! Skeleton! New York: Platt and Munk, 1991. Wolff, Angelika. Mom! I Broke My Arm! New York: Lion Press, 1969.