Bone fracture in children
Child bones have a higher risk of fracture than adult bones. The reason for this is that the skeleton of a child is still in the process of building up. The growth joints (epiphysis joints) are not yet closed and the inner and outer periosteum (endosteum and periosteum) are also still being built up.
The most common fracture in children is the fracture of the wrist (distal radius fracture), i.e. a fracture of the radius directly above the wrist. Injuries to the elbow are also common, but these usually involve a dislocation (dislocation) and more rarely a fracture of the joint. Fortunately, children in general are more likely to suffer a fracture of the bone shaft than of the joints.
Joint fractures are much more difficult to treat and often involve surgery. Children also have special types of fractures that are not found in adults due to the mature bone structure. These include the so-called greenwood fracture, the compression fracture and the epiphyseal injury.
In children, fractures generally heal more quickly than in adults, and malalignments caused by the fracture can even be compensated for by longitudinal growth. However, the potency of the possible correction depends on the age of the child, the affected bone and the type of malalignment, and the healing process should always be medically monitored. On the other hand, fractures of the child’s skeleton carry the risk of growth disorder, especially fractures of the bone shaft or near the growth plate.
Stimulation of the growth plate can lead to an excessive increase in the length of the bone, so that in 2/3 of the children with growth plate injuries, an additional length growth of 1 cm is recorded. On the other hand, if the growth plate is partially closed in the event of a fracture, incorrect growth and shortening of the bones may occur. Whether or not a broken bone needs surgery depends on various factors.
For example, apart from the operation, the bone can of course only be immobilized. This is usually done with a plaster cast, which must be worn for several weeks. During this time, the broken bone should be subjected to as little stress as possible.
In addition, care must be taken that a fresh fracture always causes swelling. For this reason, a fresh fracture is always treated with elastic material before a plaster cast is applied. A plaster that is too tight can lead to compartment syndrome, but this complication is also possible without a plaster cast.
If the fracture is first treated with a bandage, compartment syndrome can be detected much more easily than if a plaster cast is applied.
- Whether the bone has fallen into a malposition after the fracture and would grow together “incorrectly” without surgery,
- What kind of fracture is involved (comminuted fractures,.) ,
- Where the break is,
- How high is the complication rate
- And of course the age of the patient.
Surgery is often only performed on displaced fractures, but not all displaced fractures have to be operated on.
A broken bone can also be reduced manually, thus often saving the patient from surgery. However, surgery is unavoidable if the fracture has shifted and cannot be repositioned without surgery. If the bone shows a tendency to shift again after manual reduction, it may also be necessary to operate on the bone. Apart from this, a bone fracture must be operated on if the surrounding soft tissues, i.e. muscles and nerves, are also injured. If this is the case, it is often an open fracture.
