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Broken Bones 101

Dr. Vinitha Shenava, pediatric orthopedic surgeon at Texas Children’s Hospital West Campus

The start of a new school year brings football, volleyball, basketball–and sometimes a broken bone to go along with these and other athletic activities. Here’s what you can expect as a result.

As a pediatric orthopedic doctor, I see tons of broken bones, especially during the summer when kids spend more time outdoors. It’s not uncommon to see broken arms, collar bones or ankles.

The most common broken bone we see is forearm fractures. When children are falling, they’ll often try to brace themselves with their arms, causing fractures of their shoulder, elbows, forearms or wrists. It’s important to note that not every fall results in a broken bone. Therefore, paying attention to classic signs that could indicate a broken bone such as an audible snap, pain, the inability to touch or move the injured area, swelling, tenderness, bruising, or even deformity (the area looks curved or crooked) is very important. Occasionally a broken bone will also be associated with a tear or opening in the skin which is an even more serious injury. If you suspect a child has a broken bone, it’s important to seek medical attention immediately.

When we first see children with a suspected broken bone, we will get an X-ray of the area. This allows us to see the bone, see if it’s broken and determine the extent of the injury. Depending on the location of the fracture, we might order an MRI or CT scan. This allows us to evaluate the fracture in 3 dimensions which is helpful in unusual or complex fractures.

The majority of fractures in children can be treated with a cast. However, a small percentage are best treated by surgery due to their location or if the bones are not well aligned. All orthopedic surgeons have the ability to treat fractures, but ones that occur in children possess unique qualities that occasionally are best treated by pediatric orthopedic surgeons who have additional training in caring for musculoskeletal problems in children.

One factor unique to children is the fact that their bones are actively growing, so some fractures will improve their alignment (remodel) with growth. Another issue is that children’s bones differ from adults because they have growth plates (also called physes) and fractures in children can involve the growth plate. The growth plates are located at the ends of long bones, such as those in the arms and legs, and allow the bone to grow in length. They are made of cartilage, a soft rubbery material, which can be vulnerable to injury. In fact, when damaged, the bone can sometimes stop growing partially or completely. Treatment by a medical provider who is knowledgeable in these types of injuries, especially one with expertise and experience in treating pediatric patients, is necessary to prevent issues in adulthood. Children can sustain growth plate injuries from falling during a wide variety of activities. Contact and repetitive sports such as basketball, football, gymnastics, skateboarding, bicycle riding and flipping on the trampoline are common causes. In order to minimize further injury, these fractures may require surgery or follow up on a long term basis to monitor for any permanent damage.

In general, children make a full recovery following a fracture and are usually back to running around, cast free, within a few months.

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january, 2021

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