Broken & Fractured Bones in Babies & Children
Always Remember Don't Panic
Stop, Breath & Think.
Table of Contents
A bone fracture is a medical term for when the continuity of a bone is broken. It means the same things as a broken bone. Most of the time the fracture can only been seen with an x-ray. A broken bone in a child is different from one in an adult, because young bones are more flexible and have a thicker covering, which makes them better able to absorb shock. Children’s fractures rarely require surgical repair. A large percentage of fractures occur because of sudden high force, impact or stress on the bone. Fractures are a common childhood injury due to children exploring the world around them being adventures and generally have little fear when playing. They are full of energy and majority of children love climbing and getting into things they shouldn’t. They have a more physically active lifestyle than adults. A large percentage of fractures occur because of sudden high force, impact or stress on the bone caused from falling of playground equipment or bikes and skateboards.
Fractures can occur in any bone of the body but the most common fracture injuries in children are wrists, arms and elbows, which usually occur after a fall.
Most fractures heal well and cause no long-term complications.
Causes of Broken Bone & Fractures
In fact, they are the fourth most common injury among children under age six. Falls cause most of the fractures in this age group, but the most serious bone breaks usually result from car crashes.
Most fractures are caused by a bad fall or motor vehicle accident.
In baby and toddlers the most common cause of fractures is slips and falls
Healthy bones are extremely tough and resilient and can withstand surprisingly powerful impacts. As people age, two factors make their risk of fractures greater: Weaker bones and a greater risk of falling.
Children, who tend to have more physically active lifestyles than adults, are also prone to fractures.
People with underlying illnesses and conditions that may weaken their bones have a higher risk of fractures. Examples include osteoporosis, infection, or a tumor. As mentioned earlier, this type of fracture is known as a pathological fracture.
Stress fractures, which result from repeated stresses and strains, commonly found among professional sports people, are also common causes of fractures.
Types of Fractures
Bones can fracture in a multitude of way and some names and terminology are simple to understand for example a hairline fracture, which is self-explanatory, but some of the terminology and names can be very difficult to understand. Some fractures are more common at different ages due to the process our bones go through in life. Children’s bones have a tendency to be more like elastic whilst the elderly have brittle bones that break easily. Children also have growth plates at the end of their bones – areas of growing bone – which may sometimes be damaged.
Some of the common fractures in Children that you will hear are Bend Greenstick, Hairline, un-displaced and Torus fractures, this is due to children’s bones having a tendency to bend.
Majority of the time the doctor will just inform parents that the bone is fractured or broken so as not to complicate or worry the parent with terminology.
Here are some of the more common types of fractures and there meaning that you may hear:
- Avulsion fracture – a muscle or ligament pulls on the bone, fracturing it.
- Bend Fracture – a bone that is bent but not broken and is also relatively common among youngsters.
- Comminuted fracture – the bone is shattered into many pieces.
- Compression (crush) fracture – generally occurs in the spongy bone in the spine or a blunt force in the hand. For example, the front portion of a vertebra in the spine may collapse due to osteoporosis, or a hammer hitting a fingertip
- Fracture dislocation – a joint becomes dislocated, and one of the bones of the joint has a fracture. These are more serious than simple fractures.
- Greenstick fracture – the bone partly fractures on one side but does not break completely because the rest of the bone can bend. This is more common among children, whose bones are softer and more elastic.
- Hairline fracture – a partial fracture of the bone. Sometimes this type of fracture is harder to detect with routine xrays.
- Impacted fracture – when the bone is fractured, one fragment of bone goes into another.
- Intraarticular fracture – where the break extends into the surface of a joint.
- Longitudinal fracture – the break is along the length of the bone.
- Oblique fracture – a fracture that is diagonal to a bone’s long axis.
- Open or compound fracture – the bone ends don’t line up and one end of the broken bone protrudes through the skin. This kind of fracture can easily become infected.
- Pathological fracture – when an underlying disease or condition has already weakened the bone, resulting in a fracture (bone fracture caused by an underlying disease/condition that weakened the bone).
- Spiral fracture – a fracture where at least one part of the bone has been twisted.
- Stress fracture – more common among athletes. A bone breaks because of repeated stresses and strains.
- Torus (buckle) fracture – bone deforms but does not crack. More common in children. It is painful but stable.
- Transverse fracture – a straight break right across a bone.
- Un-displaced fracture – the bone is cracked but still in the correct position for healing.
Fractured Growth Plates
Because your child’s bones are still growing, he is vulnerable to an additional type of fracture that does not occur in adults. This involves damage to the growth plates at the ends of the bones, which regulate future growth. If this part of the bone does not heal properly after the fracture, the bone may grow at an angle or more slowly than the other bones in the body. Unfortunately, the impact on the bone’s growth may not be visible for a year or more after the injury, so these fractures must be followed carefully by the pediatrician for twelve to eighteen months to make sure no growth damage has occurred.
Fractures that involve injury to the growth plate sometimes need surgery to minimize the risk of future growth problems. Fractures around the elbow often cause the arm to heal abnormally, resulting in a crooked position. Many require surgery to minimize this risk. Children with fractures near the elbow may be referred to an orthopedic specialist.
Signs & Symptoms of a Fracture
Older children will usually be able to tell you where they are sore and can explain what happened to cause the injury. This can make it easier to identify if a fracture has occurred. It can be more difficult to identify a fracture in infants or toddlers. They may cry and not use the affected area, but there may be no obvious injury.
If you think your child has a fracture, they may have the following symptoms:
- pain or tenderness at the injury site
- swelling around the injury
- bruising in the area
- discolored skin around the affected area
- angulated or deformity (unusual shape) of the injured area.
- unable to put weight on the injured area
- not wanting to move or use the injured area.
On rare occasions the force of an injury can causes the skin over a fracture to split – this is called a compound fracture. There may only be a small break in the skin (the bone may not be sticking out of the wound). If this has occurred, it is important to go to your local hospital emergency department.
If the break is in a larger bone like the pelvic or femur (leg bone coming from the pelvis) they may
- look pale and clammy
- there may be dizziness (feeling faint)
- feelings of sickness and nausea.
Sometimes children will not have any of the above symptoms and a fracture may not be noticeable even if an injury has occurred.
First Aid
Always remember DRSABCD, don’t panic, and if possible, take notice of the time.
Check for danger in the area and make sure it is safe.
Stay calm no matter what the situation, your voice is the biggest comfort to your injured child. If you are panicking the child will panic, if your voice is calm and comforting, your child will be less likely to panic.
Don’t move them until you have evaluated the situation and possible injuries.
Control any bleeding and cover any wounds.
Once you have evaluated and believe it is safe to move them to a more comfortable area, support the injury as you do so. This can be done by simply holding the area or even using their t-shirt like a sling.
Now your aim is to provide comfort to your child, help to reduce swelling, and provides your child with pain relief.
If it is a minor closed fracture, and the child is not showing signs of shock or vomiting, it is okay to give them some pain relief (e.g. paracetamol or/and ibuprofen).
Try to reduce movement of the injured area, by applying a splint or sling. There are many items around your house that can be used as a splint. Lids from plastic containers are always on hand and can make the perfect splint, they are light, sturdy and come in all different sizes. To add padding to the lid you can place the lid into a winter night sock. Another great splint especially for the leg is the general kitchen tongs in a sock. Place the tongs on each side of the leg and strap them in place with a bandage.
For a makeshift sling think of available material in your house, like a scarf or a pillowcase or even the child’s t-shirt if they are wearing one.
Apply a cold pack to the injured area can help reduce the swelling and decrease the pain.
Elevate the limb if possible as this can also reduce the swelling in the area.
Check for blood flow to the area by pressing lightly at the end of the finger or toe area. Once you remove your finger from the area the white should instantly turn to normal colour as blood flows back to the area.
Seek medical attention.
Helpful Tips On How To Strap a Fracture
To strap a broken limb, you can follow these steps:
- It can be difficult for a first aider to tell whether the injury is a fracture, dislocation, sprain or strain. If in doubt, always treat the injury as a fracture.
- Use broad bandages to immobilize the fracture and to prevent movement at joints above and below the fracture.
- Place a padded splint along the injured limb and bandage. For open fractures bandage above and below the fracture site.
- For open fractures leave a five-centimeter gap on either side of the fracture to prevent movement.
- If the limb is very young and small, use a piece of cotton fabric as a sling.
- support the limb, carefully passing bandages under the natural hollows of the body
- place a padded splint along the injured limb
- place padding between the splint and the natural contours of the body and secure firmly
- for leg fracture, immobilise foot and ankle
- If collarbone is fractured, support arm on injured side in a sling.
- If you suspect the joint is dislocated, rest, elevate and apply ice to the joint.
- check that bandages are not too tight (or too loose) every 15 minutes.
- Watch for signs of circulation loss to hands and feet
- Do not attempt to force a fracture or dislocation back into place – this could cause further injuries.
When To See A Doctor
If you think your child has a fracture, or you are unsure, you are best to go see your GP.
If you believe your child has fracture or severe injury, go to your local hospital emergency department.
GP – General Practioner.
In most cases, a GP will assess the injury first. If they feel there is the slightest possibility of a fracture, they will refer to your local radiologist for an x-ray to confirm the fracture, location and type of fracture. If a fracture is seen on the x-ray, the doctor will strap the area, and you will be referred to a fracture clinic or the local hospital for a cask (plaster).
Call an ambulance or take your child to your local emergency department immediately if:
- your child has injured themselves and they are in severe pain
- a limb looks deformed
- a limb looks blueish or is an unusual colour
- your child has a limb injury and there is a large cut where the injury has occurred
- a bone is sticking out, or if there is a large amount of bleeding that cannot be stopped.
Treatment
Medical treatment focuses on supporting the bone as it heals naturally. For bones to heal they must line up.
Treatment will always be dependent on the type of fracture your child has sustained, the bone that has been fractured and any other injuries the child may have also been sustained.
If your child has a fracture, they will need to restrict movement of the injury site to allow the bone time to heal.
Some minor fractures may require a splint or backslab (partial cast), held in place with bandages. A splint or partial cast helps to support the injured area, allowing it to rest and heal while also providing your child pain relief. A splint or partial cast generally does not have to be worn for as long as a full cast.
Casts are generally required to be worn for three weeks to three months depending on the type and location of the injury – your doctor or specialist will estimate how long it will be required.
If the injury has caused the bones to move out of place, a doctor, nurse practitioner or, in some cases, a surgeon will need to move the bones back into the correct position (known as a reduction). These procedures are usually done under sedation or anesthesia in the emergency department or operating theatre. Fractures that require a reduction will need a full plaster cast (one that wraps around the limb) to allow the injury to heal. Full plaster casts stay on your child for up to three months, depending on the injury.
When a broken bone doesn’t or wouldn’t heal properly with casting or splinting alone, surgical intervention may be required. Bone fracture repair is a surgery to fix a broken bone using metal screws, pins, rods, or plates to hold the bone in place. It’s also known as open reduction and internal fixation (ORIF) surgery.
- Plaster casts or plastic functional braces – these hold the bone in position until it has healed, or provide pain relief whilst the bone is healing
- Metal plates and screws – current procedures may use minimally invasive techniques.
- Intra-medullary nails – internal metal rods are placed down the center of long bones. Flexible wires may be used in children.
- External fixators – these may be made of metal or carbon fiber; they have steel pins that go into the bone directly through the skin. They are a type of scaffolding outside the body.
Usually, the fractured bone area is immobilized for 2-12 weeks. The duration depends on the age of the patient, which bone is affected, the type of fracture and whether there are any complications, such as a blood supply problem or an infection.
People usually stop feeling pain long before the broken bone has healed and the limb is ready for regular activity.
Cast
The purpose of a cast or splint is to immobilize a bone or joint while it heals from injury. This helps to restrict movement and protect the area from further injury.
Doctors sometimes use casts and splints together. For example, they might stabilize a fracture with a splint first and replace it with a full case after the initial swelling goes down. Other fractures might need just a cast or just a splint.
Plaster of Paris 
This is the traditional casting material that is white in colour, and powdery. To apply it can be messy and usually involves wetting the plaster in water and applying to the arm. They are often used following surgery or initially after an injury when swelling is present and are made in this instance as half casts (not going the whole way around the arm). It a plaster of Paris cast becomes wet, it will soften very easily, so they must be kept dry at all times. Half casts are usually held in place with a bandage and can be removed easily. Full casts need to be removed with a plaster saw.
Synethetic Casting 
Synthetic casting material is lighter than a normal plaster of paris cast and will often last longer as it can withstand stress better. It comes in lots of different colours and can also come in patterns, such as dinosaurs, or army camouflage. There are then options of what type of padding goes under a synthetic cast. Having a synthetic cast on alone does not mean it is waterproof. The waterproof part of a cast is mainly to do with the padding that is applied underneath the cast. Some synthetic casts have a cotton wrap or cotton wool type padding underneath – this is not waterproof! These casts need to be removed with a plaster saw.
Waterproof Casting 
This is very popular, especially at summertime with our water lifestyle. Waterproof casting is simply a synthetic cast with waterproof padding underneath. When you have a waterproof cast, you can get in the shower without putting a bag on and can swim in a pool (depending on your injury). The water will flow between your skin and the padding. It is quick drying and therefore there are no bad odors. It is lightweight and comes a variety of bright or modern colors.
Three Stages of Bone Healing
When someone breaks a bone, they typically go through three stages of healing:
1. The inflammatory phase
The inflammatory phase, also called fracture hematoma formation, is the first stage of healing that occurs immediately after the injury.
According to one study, approximately 48 hours after the injury, blood vessels torn by the fracture release blood. This blood starts to clot and forms a fracture hematoma. Because of the disruption of blood flow to the bone, some bone cells around the fracture die.
This inflammatory stage ends approximately one week after the fracture.
2. The repairing phase
The repairing or reparative phase begins within the first few days after the bone fracture and lasts for about 2 – 3 weeks. During this time, the body develops cartilage and tissue in and around the fracture site.
The tissue forms a soft collar at the broken ends of the bones, and the tissue grows until the two ends meet. These growths are known as calluses, and their purpose is to stabilize the fracture. Over the following weeks, a bony callus made of spongy bone called trabecular bone will replace the tissue callus.
3. Bone remodeling
The remodeling phase is the final phase in fracture healing.
At this stage, solid bone replaces spongy bone, completing the healing process. Sometimes, the outer surface of the bone remains slightly swollen for some time, which should resolve on its own.
Care At Home
Encourage your child to rest for the first few days following a fracture. Your child should also avoid physical activities – if a child falls onto their plaster cast or damages it, the fractured bone can move out of alignment and it may not heal in the correct position.
When caring for a fracture at home, it is important to:
- monitor your child’s pain
- keep the injured area elevated to reduce swelling
- monitor your child’s skin and follow any instructions given to you by your doctor to care for the cast.
Casts and splints should remain dry at all times. If they become wet, the splint can become damaged and the skin underneath can become irritated.
Your child should never sleep with their sling on, so remember to remove your child’s sling before bedtime. Try and keep the injured area elevated for at least the first three nights (or longer if directed by your doctor) by using an extra pillow or folded blanket.
For tips on how to relieve itching and for more information about caring for a cast at home, see our fact sheet Plaster cast care.
Looking After The Cast
You will be given specific instructions for looking after your child’s plaster cast, bandage, or splint at home.
Parents and carers will need to help their child to:
- elevate or lift the fractured bone where possible, propping it up on a pillow when sitting or lying down
- avoid resting the plaster cast on any hard surfaces to prevent pressure sores
- use any slings, crutches or wheelchairs as directed by the doctor or physiotherapist
- wrap the cast with a plastic bag and tape during showers and baths, keeping it out of the water
- let small amounts of moisture on the cast air dry naturally
- keep the cast away from direct heat, like hot water bottles, hair dryers and electric blankets
- leave the cast alone, avoiding moisture, heat, and cuts to the plaster.
If the cast becomes loose, cracked, or soft or does not keep the bone in place properly, take your child to the nearest emergency department.
Healthy Healing
Protein
As a large part of a bone is composed of protein, giving a child that has food high in protein such as eggs, chicken breast and Salmon can help the bone to rebuild and heal itself.
Antioxidants
Antioxidants remove free radicals that are generated by tissue damage. Because bone fractures cause tissue damage, taking antioxidant supplements may help with bone healing.
People can find antioxidants in supplements that contain vitamins E and C, lycopene, and alpha-lipoic acid.
Minerals
Bone is mostly composed of minerals, including calcium, silicon, magnesium, phosphorus, and zinc. People may find that their bone heals faster if they increase their intake of these minerals.
These minerals may speed up callus formation, increase the production of bone protein, and accelerate the bone healing process.
Vitamins
Vitamins are also essential for bone rebuilding as they promote most of the cellular processes and reactions that occur in bone.
Vitamins C, D, and K play vital roles in the fracture healing process. Vitamin B is essential for energy production.
Exercise
Exercise
Always speak to a doctor before using exercise as a way to speed up bone healing, as it will only be appropriate at certain stages of the healing process.
However, if performed under a doctor’s supervision, exercise can improve blood flow to the injured site, help to rebuild muscle around it, and speed up bone fracture healing. Furthermore, some people may regain limb function through exercise.
Follow-Up
After seeing your GP or doctor, your child may have a follow-up appointment one to two weeks after the injury. It is important to attend this appointment as your child’s fracture will be checked to ensure the bones are healing well. If your child requires any further follow-up appointments or tests, your doctor will let you know.
For most minor fractures, your local GP can manage your child’s ongoing follow up. However, some fractures will require a follow up X-ray and review by an orthopaedic surgeon who will tell you how long your child needs to have their cast on.
At any time, take your child back to your GP or local hospital if:
- the cast is cracked, soft, too loose, too tight, or has rough edges that hurt
- you are worried that an object has been pushed inside the cast
- there is a bad smell or ooze coming from the cast
- your child is in increasing pain
- you are concerned for any other reason.
After The Cast Is Removed
Once the cast has been removed, your child’s skin may be dry and itchy. Bathe the skin with warm soapy water, and apply a plain, non-perfumed moisturiser.
After a fracture, children normally regain strength by gradually participating in gentle activity and play.
Physical therapy – after the bone has healed, it may be necessary to restore muscle strength as well as mobility to the affected area. If the fracture occurred near or through a joint, there is a risk of permanent stiffness or arthritis – the individual may not be able to bend that joint as well as before.
Surgery – if there was damage to the skin and soft tissue around the affected bone or joint, surgery may be required.
Your doctor will give you specific advice about when and how your child can return to sport (usually about four to six weeks after the cast is removed). If your child had surgery, full contact sports should be avoided for two to three months, but you should discuss this with your child’s doctor.
Delayed Unions And Non-Unions
Non-unions are fractures that fail to heal, while delayed unions are those that take longer to heal.
- Ultrasound therapy – low-intensity ultrasound is applied to the affected area daily. This has been found to help the fracture heal. Studies in this area are still ongoing.
- Bone graft – if the fracture does not heal, a natural or synthetic bone is transplanted to stimulate the broken bone.
- Stem cell therapy – studies are currently underway to see whether stem cells can be used to treat fractures that do not heal.
Complications
Heals in the wrong position – this is known as a malunion; either the fracture heals in the wrong position or it shifts (the fracture itself shifts).
Disruption of bone growth – if a childhood bone fracture affects the growth plate, there is a risk that the normal development of that bone may be affected, raising the risk of a subsequent deformity.
Persistent bone or bone marrow infection – if there is a break in the skin, as may happen with a compound fracture, bacteria can get in and infect the bone or bone marrow, which can become a persistent infection (chronic osteomyelitis).
Patients may need to be hospitalized and treated with antibiotics. Sometimes, surgical drainage and curettage is required.
Bone death (avascular necrosis) – if the bone loses its essential supply of blood it may die.
Strengthening
Nutrition and sunlight – the human body needs adequate supplies of calcium for healthy bones. Milk, cheese, yoghurt, and dark green leafy vegetables are good sources of calcium.
Our body needs vitamin D to absorb calcium – exposure to sunlight, as well as eating eggs and oily fish are good ways of getting vitamin D.
Vitamin D plays a role in maintaining healthy bones.
Physical activity – the more weight-bearing exercises you do, the stronger and denser your bones will be.
Examples include skipping, walking, running, and dancing – any exercise where the body pulls on the skeleton.
Key Points To Remember
- Fractures are a common childhood injury because children’s bones are not yet fully developed.
- “You don’t want them to grow up with a sedentary lifestyle,” she says “It’s about encouraging them to take risks, but not extreme risk. We need to set some boundaries, understand the hazards and manage the risks.”
- Most fractures heal well and cause no long-term complications.
- Fractures are usually treated by using a splint or a cast (full or partial) to restrict movement until the bone heals.
- Looking after the cast is important to ensure your child’s bone heals correctly and to prevent damage to their skin.
- Depending on the type of injury, the cast will need to stay on for up to three months and your doctor will let you know if you require any follow up appointments.
Statistics
Australian hospitalisation and mortality records during 1 July 2002 to 30 June 2012 show the following statistics
Twice as many boys as girls were hospitalised for fractures – around 820 hospitalisations per 100,000 boys – compared to girls with around 416 hospitalisations per 100,000, the AIHI study found.
New research from the Australian Institute of Health Innovation at Macquarie University published in the journal Injury, shows that young males account for two thirds of fracture-related hospital admissions with most injuries for all children resulting from a fall.
Hospital readmissions were frequent following fractures sustained in a fall, predominantly from playground equipment.
Videos
At Home Support
How to treat a fracture.
University Lecture
How to strap a wrist
