Warmer weather means children are spending more time outside. Whether on the trampoline, riding a skateboard or playing spring sports, the season of activity leads to an increase in injuries. Before you wrap your child in bubble wrap, here’s what you should know from Michael Conklin, MD, a pediatric orthopedist at Children’s of Alabama and associate professor of pediatric orthopedic surgery at UAB about bone fractures.
1. Children break bones differently than adults do
All children have growth plates in their bones close to the joint, like the knee. Say a child experiences some kind of twisting force. For an adult, it might cause you to rupture a ligament. But, for a child, it would fracture through the growth plate.
Growth plate fractures can cause problematic issues that a specialist looks out for when taking care of an injured child versus an adult.
“One other difference in children’s bones is that they’re more pliable or flexible. They get a type of fracture that you don’t see in an adult, called greenstick fractures. (The fractures) bend and become deformed, but don’t completely break in two.”Michael Conklin, MD, Pediatric Orthopedist, Children’s of Alabama
2. Greenstick and buckle are the most common types of bone fractures in children
Speaking of greenstick fractures, in addition to the milder buckle fracture, these two injuries are generally the most common in children. You’ll find them happen particularly around the wrist and forearm.
In cases of minor injuries, where the child is moving about but is still hurting after a couple of days, it’s likely one of these two fractures. If there’s no deformity, a greenstick or buckle fracture may not even need splinting.
3. The first form of first aid you can take is splinting
If the injury is more serious, you should initially immobilize and elevate the fracture. Splint the upper or lower extremity, put something firm on it and wrap the injury with a bandage.
For acute injuries, ice is helpful to reduce swelling. You don’t want to leave it on for over 20 minutes or have the ice directly touching the skin. Wrapping ice in a towel prevents freezer burn of the skin.
4. If the bone fracture looks intense, don’t feed your child before bringing them to the emergency room
When there’s a clear deformity in the child’s bones, it’s time to bring them in straight away to the ER. It’s vital that you don’t give them anything to eat or drink beforehand.
“If a fracture looks very displaced where they can look at the arm and it looks deformed, that kid is going to need to come to the emergency department. Most likely, they’re going to have either sedation or surgery.”Dr. Conklin
The sooner specialists can fix the break, the better. When the child eats or drinks ahead of surgery, it puts a hold on the process. Many times, doctors have to wait eight hours after that meal before they can help heal the child.
Because you can wiggle your toes doesn’t mean it’s not a serious break
Like we mentioned above, always bring the child into the ER if there’s an unnatural deformity to the bone. Some patients believe that if you can wiggle your fingers or toes it’s not something that will require a visit to the doctor and may sit on the injury for weeks.
“The old wives’ tale that if you can move the parts downstream to the fracture it’s not broken—that’s not true.”Dr. Conklin
5. See an orthopedic surgeon if the bone needs a reduction
A reduction, or in layman’s terms “setting the bone,” is typically done by an orthopedic surgeon and not the pediatrician.
“Certainly displaced fractures need to come to us. So if they see physical deformity, most likely, the family’s not going to want to accept that deformity and let the child heal in that position.”Dr. Conklin
6. Vitamin D is one way to build bone health and prevent bone fractures
So we know what to do if a child experiences a bone fracture or break, but what about preventing them? Dr. Conklin strongly recommends adding vitamin D supplements to your child’s everyday routine.
“For bone health, vitamin D is really important. About 50% of American children are vitamin D deficient or insufficient.
There’s basically an epidemic of vitamin D insufficiency out there…We think there is a relationship between even mild to moderate amounts of vitamin D deficiency and fractures.”Dr. Conklin
The American Academy of Pediatrics recommends 400 international units of vitamin D per day for every child. However, as more research develops on the link between vitamin D and bone health we could see this number increase.
7. You can trust the experts at Children’s of Alabama
When it comes to bone fractures, the trained staff and doctors at Children’s of Alabama are experts at knowing what path to take—whether it’s surgery, casting or other treatment.
By going to a pediatric orthopedist, you could save the child from being over-treated as well. Remember, children’s bones have the capability of correcting a certain amount of deformity.
“That’s one of the biggest parts about being a pediatric orthopedist—trying to understand which fractures will remodel and walking the parents through it so that they don’t undergo unnecessary interventions.”Dr. Conklin
If an injured kid ends up needing surgery, you can feel more at ease knowing the team at Children’s of Alabama is trained in understanding how a child’s bones will heal and the best way to get them back to 100% healthy.
“When we have made the decision to operate on a fracture, it’s because of our understanding and our expertise in which fractures can be treated nonoperatively and which need surgery… We know that we can treat the vast majority of fractures in children nonoperatively.
So, if we say that we think the child needs surgery, then they’re going to a pediatric orthopedic surgeon who knows that end of the business. They have to trust that we have the child’s best interests in mind.”Dr. Conklin