Common Fracture Injuries in Children: What to Know

Mark Steven Schwartz, D.O.

First things first: a “fracture” is medical terminology for a broken bone, so a “break” and “fracture” are the same thing. I’m Dr. Mark Schwartz, I’m a Pediatric Orthopedic Surgeon with Saint Francis Children’s Physicians, and here we’ll talk about the most common fractures we treat in children, how we treat them and signs and symptoms parents/caregivers can watch for.

Kids’ Most Common Fractures

The most common fractures we see in children are wrist and elbow fractures. When kids fall, they tend to reach out with the arms, so wrist fractures are the number one thing I see day-to-day, followed by elbow fractures.

We often treat kids’ wrist and elbow fractures in office. We’re able to treat many younger kids with leg fractures in the office as well. 

Once kids start getting older, bigger fractures like femur fractures and tibia fractures tend to need more acute care in the hospital as opposed to being taken care of in the office. But we take care of quite a few lower-extremity fractures in the office as well.

How to Identify a Fracture

If your kid falls and has an obvious deformity of their arm or leg, they need to be seen immediately—they likely have a fracture that needs to be reset in the emergency department or in the operating room. 

Non-displaced fractures are more difficult to discern. If your kid starts to have swelling or bruising, is not bearing weight on an injured leg, or if they’re still crying for more than 20-30 minutes after an injury, they should be seen by a doctor. 

If your kid is quickly consolable and isn’t hurting within an hour or two, then they’re probably OK. But if parents have any concern, getting them in and getting an X-ray is always a good option to avoid delaying care for an injury that may need care sooner rather than later.

Treating and Healing Kids’ Fractures

Kids do heal fractures faster than adults—typically between four and six weeks. There’s a layer of tissue surrounding the bones that is a lot thicker in children, creating better blood flow to the bones. 

The younger the child, the faster they heal. Some of the wrist fractures I take care of in kids are healed within three or four weeks. For older teenagers, you’re looking at closer to six weeks.

Sometimes we can use different types of braces for certain fractures. However, the majority of fractures I take care of do get casts.

We really try to put kids into waterproof casts at our office so they can participate in activities like swim classes. It’s helpful for the families because it allows them to shower and bathe their kids and not end up with really stinky casts at the end of it. They also don’t have to wrap their arms or legs in a plastic bag to keep the cast dry.

Some fractures do end up needing surgery. While we try to avoid surgery, sometimes it’s necessary, depending on the type and location of the fracture. 

Some fractures tend to be more unstable than others and just can’t be held appropriately inside of a cast, and those are the ones that we tend to treat surgically. I discuss the options of operative versus non-operative treatments with the family to see if we can avoid surgery, it’s a last resort for a child’s fracture.

Long Term Impact of Childhood Fractures

Growth plates are areas of new bone growth in children and teens—they’re made of cartilage and are located at each end of a long bone (bones that are longer than they are wide, femur and forearm for example). As kids grow, the plates make the bones longer and wider until they eventually harden into solid bone during puberty.

A lot of pediatric fractures involve the growth plate, which requires different care than that of an adult. It’s really important that those fractures are taken care of quickly and appropriately so kids can continue to grow normally.  

Pediatric orthopedic surgeons have extra training specifically for treating growth-plate fractures. Most growth-plate fractures continue to grow normally and don’t have long-term problems, but it’s important to be seen by a pediatric orthopedic surgeon.

There are some fractures that tend to be more prone to re-fracturing—middle of the forearm fractures in particular. We treat those a little more conservatively and keep kids in a brace with activities a little bit longer than we do the other fractures. 

Once you get past a certain point, usually these fractures heal completely, and the kids are at no more risk for breaking that same bone as they are any other bone in their body.

Key Takeaways

• The most common fractures we see in children are wrist and elbow fractures
• If your kid falls and has an obvious deformity of their arm or leg, they need to be seen immediately
• If your kid starts to have swelling or bruising, is not bearing weight on an injured leg, or if they’re still crying for more than 20-30 minutes after an injury, they should be seen by a doctor
• The younger the child, the faster they heal
• A lot of pediatric fractures involve the growth plate, which requires different care than that of an adult. It’s really important that those fractures are taken care of quickly and appropriately so kids can continue to grow normally
• Middle of the forearm fractures are the most prone to re-fracture