Pediatric Fractures

Childhood fractures occur frequently. From common injuries such as broken wrists or elbows to those that are more complex involving multiple bones, pediatric orthopedists at Emory have the experience to treat your child's injury expediently and appropriately. Each child is monitored after his or her injury to ensure that all fractures heal and that no growth plate injury occurred at the time of initial fracture. Potential complications of broken bones including incomplete healing, infection, or injury to the growth plate of the bone may need treatment after the injury. Your child's surgeon will be able to discuss the injury, treatment, and what you can expect down the road.

Pediatric Elbow Fractures

When a child falls on an outstretched arm, the pressure of hitting the ground could be enough to fracture, or break, a bone around the elbow. These fractures that occur in, or around, the elbow account for about 10% of all fractures in children.

Symptoms
• Severe pain in the elbow and forearm
• Occasionally numbness in the hand, if nerve injury has occurred
• Tenderness
• Swelling (may be severe or mild)
• Bruising
• Limited movement

If your child complains of elbow pain after a fall and refuses to straighten his or her arm, see a doctor immediately.

Pediatric Forearm Fractures

Forearm fractures account for 40% to 50% of all childhood fractures. Children love to run, hop, skip, jump and tumble. But if a child falls onto an outstretched arm, he or she might break one or both of the bones in the forearm.

Symptoms and Signs
• Severe pain
• Numbness in forearm and hand
• Any type of deformity about the elbow, forearm, or wrist
• Tenderness
• Swelling
• An inability to rotate or turn the forearm

Pediatric Growth Plate Fractures

Growth plates are areas of developing cartilage tissue near the ends of long bones. The growth plate regulates and helps determine the length and shape of the mature bone. The long bones of the body do not grow from the center outward. Instead, growth occurs at each end of the bone around the growth plate. When a child becomes full-grown, the growth plates harden into solid bone.

Growth plates are located between the widened part of the shaft of the bone (the metaphysis) and the end of the bone (the epiphysis). This diagram of a femur (thighbone) shows the location of the growth plates at both ends of the bone.

Because growth plates are the last portion of bones to harden (ossify), they are vulnerable to fracture. In fact, because muscles and bones develop at different speeds, a child's bones may be weaker than the ligament tissues that connect the bones to other bones.

Children's bones heal faster than adult's bones. This has two important consequences:
• A child with an injury should see a doctor as quickly as possible, so the bone gets the proper treatment before it begins to heal. Ideally, this means seeing an orthopaedic specialist within 5 to 7 days of the injury, especially if manipulation to align the bone is required.
• The fracture will not need to stay in a cast for as long as an adult fracture would require for healing.

Appropriate evaluation by an orthopaedic surgeon experienced in orthopaedic trauma will determine the nature of the growth plate injury, will provide counseling about treatment options, and will allow for longer term follow up to assess the outcome of the injuries.

Pediatric Femur Fracture

Events with the highest risk for pediatric femur fractures include:
• Falling hard on the playground
• Taking a hit in contact sports
• Being in a motor vehicle accident
• Child abuse

Thighbone fractures are classified depending on:
• Location of fracture on the bone (proximal, middle, or distal third of the bone shaft)
• Shape of the fractured ends — bones can break all kinds of ways, such as straight across (transverse), or angled (oblique)
• Position of the fractured edges (angulated or displaced)
• Number of fractured parts
   o Two parts
   o Several fractured parts (comminuted)

Symptoms
• Severe pain
• Thigh is noticeably swollen or deformed
• Your child is unable to stand or walk
• There is a limited range of motion of the hip or knee

Take your child to the emergency room right away if you think he or she has a broken thighbone. Explain exactly how the injury occurred. Tell the doctor if your child had any disease or other trauma before it happened.

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Pediatric Orthopedic Treatments
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