Pediatrics - Fractures
Bones are the hardest tissues in the body. Although bones are strong, they can split or break under too much pressure or force. A broken bone is called a fracture. Fractures can occur in a variety of ways. The most common causes of fractures are injuries, prolonged stress from overuse, and bone weakening diseases, such as Osteoporosis or tumors.
There are many types of fractures. They can range from a hairline crack to a bone that has broken into several pieces. Simple fractures may only require casting or splinting treatments. More complex fractures may need surgical intervention to align the bones for proper healing.
Your child’s bones are live tissues. They change and grow like the other parts of your child’s body. Most of the bones in your child’s body are composed of the same layered materials.
Fractures can also be the result of physical violence. Fractures can result from a blow with a fist or kick, or from contact with a solid weapon, such as a bat.
Although the majority of fractures result from motor vehicle crashes and falls, some fractures occur because of diseases. Osteoporosis is a medical condition that causes more bone calcium to be absorbed than is replaced. Calcium is necessary for hard healthy bones. Osteoporosis causes a reduction in bone density and brittle or fragile bones that are vulnerable to fractures. Type I Osteoporosis usually affects women between the ages of 51 and 75. Type I Osteoporosis is associated with spine and wrist fractures. Type II Osteoporosis usually affects people between the ages of 70 and 85. Type II Osteoporosis is associated with hip, pelvis, arm, and leg fractures.
Bone tumors are another disease-related cause of fractures. Most bone tumors originate elsewhere in the body and metastasize or spread to the bone. Very rarely do cancerous tumors begin in the bone. Tumors can weaken bones, making them susceptible to fractures.
The place where your child’s fracture occurs may look odd, bent, or out of place. Sometimes a broken bone may come through the skin. Your child may not be able to move or put weight on his or her limb or joint, or he or she may do so with difficulty.
A bone scan is useful for identifying bone abnormalities from Osteoporosis or cancer. A bone scan may be used to show fractures, tumors, infection, and bone deterioration. A bone scan requires that your child receive a small harmless injection of a radioactive substance several hours before your test. The substance collects in areas where the bone is breaking down or repairing itself.
In addition to diagnosing your fracture, your doctor will classify the type of fracture that your child has in order to plan treatment appropriately. Fractures are classified by a combination of general terms used to describe their features. Fractures are categorized by the characteristics of the broken bone, including the position of the fragments or broken bone and the direction of the fracture line. Common fracture characteristics and classifications are described below.
Incomplete or Partial Fracture: A crack that does not completely break the bone into two pieces.
Greenstick Fracture: An Incomplete Fracture with a bowed bone, it is more common in children.
Compound or Open Fracture: The bone fragments penetrate the skin.
Simple or Closed Fracture: The bone fragments do not penetrate the skin.
Nondisplaced: The bone is broken but maintains its alignment.
Displaced: The bone is broken and the fragments are out of position.
Segmental: More than one fracture line leads to a "floating" segment.
Angulated: The fragments are out of position and at an angle to each other.
Overriding: The fragments overlap each other.
Impacted: One piece of bone is forced into a second piece of bone.
Linear: The fracture line is parallel with the shaft (the long part) of the bone
Transverse: The fracture line is at a right (90°) angle to the shaft of the bone
Oblique: The fracture line is at a 45° angle to the shaft of the bone
Spiral: The fracture line has a “corkscrewed,” “curled,” or angled pattern
A nonunion is a fracture that just will not heal. This is usually determined by time and X-rays, which show that there is no possibility that the fracture will heal without additional intervention.
A malunion is a fracture that has healed in a position outside acceptable parameters. This can include combination of angulation, displacement, malrotation, or length differences.
Malunions and many nonunions require surgery to heal properly. Direct access to the fracture is necessary to straighten the bone, in the case of a malunion, or to remove soft tissues and stimulate blood flow at the site of a nonunion. Bone grafts are typically placed to further enhance healing.
Surgical options include procedures called an Open Reduction and Internal Fixation or an Open Reduction and External Fixation. Open Reduction and Internal Fixation refers to techniques that use surgical hardware to stabilize a fracture beneath the skin. Your surgeon will make an incision and place your child’s bones in the proper position for healing. Your surgeon will secure the bones together with surgical hardware, such as rods, screws, or metal plates.
Open Reduction and External Fixation refers to techniques that use surgical hardware to stabilize a fracture from the outside of the skin. Your surgeon will make an incision and place your child’s bones in the proper position for healing. Your surgeon will secure the bones with surgical pins placed through the outside of the skin. The surgical pins attach to a metal frame on the outside of the skin.
Prevent falls. A general physical examination can identify medical conditions that are associated with balance disorders or dizziness.
A vision exam can detect vision changes that are associated with falls. Some vision changes can be corrected with glasses.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.
The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.