Treating Children’s Fractures

Sponsored by The Children's Hospital at Saint Francis

TulsaKids has teamed up with The Children’s Hospital at Saint Francis to bring parents important health information that they need to know. Mark Schwartz is a pediatric orthopedic surgeon with Warren Clinic. He spoke with us about children’s fractures, covering common fractures, treatment options, etc.. Watch the video interview below, or read the article to learn more.

Q: Summer activities can mean more injuries, possibly broken bones. Is a broken bone the same thing as a fracture?

A: A fracture is the medical terminology for a broken bone, so a break and a fracture are the same thing.

Q: What are the most common fractures in children?

A: The most common fractures we see in children are wrist and elbow fractures. When kids fall, they tend to reach out with the arms. Wrist fractures are the No. 1 thing I see in my office, followed by elbow fractures.

Q: What are some other types of fractures that you typically see?

A: In the office, we see wrist and elbow fractures. 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.

Q: We often hear that children heal more quickly than adults. Is it true that children’s bones heal faster than adults’?

A: Kids definitely will heal faster than adults. There’s a layer of tissue surrounding the bones that is a lot thicker in children, creating better blood flow to the bones, so their fractures tend to heal faster, typically between four and six weeks. 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.

Q: What are the treatments for various types of fractures? How do you determine what will need a cast or surgery?

A: 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 kids can participate in activities like swim classes. It’s helpful for the families because it allows them to shower and bathe the 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 lean toward surgery.

We discuss the options of operative versus non-operative treatments with the family to see if we can avoid surgery. In some cases, we can. In others, surgery is necessary.

Q: How are children’s fractures different from adults’ fractures?

A: 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 the kids can continue to grow normally.  Pediatric orthopedic surgeons have extra training specifically for treating growth-plate fractures. The majority of 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.

Q: If a child has had a fracture, is that bone more compromised?

A: It depends on the fracture. There are some fractures that tend to be more prone to re-fracturing. Fractures of the middle of the forearm tend to be the highest ones for re-fracture. 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. But 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.

Q: How does a parent know when an injury is serious enough to seek care?

A: If kids fall and have an obvious deformity of their arm or leg, they need to be seen immediately because they likely need to be reset in the emergency department or in the operating room. Non-displaced fractures are more difficult to discern. If kids start to have swelling or bruising, are not bearing weight on a leg, or if they’re crying for more than 20-30 minutes after an injury, they should be seen by a doctor. If a 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.