Fractures in children are common in the age group between 1 year to 15 years. More common in boys than in girls because they are more naughty. The left upper extremity fracture seems to be common, as the left assumes the role of protection during the fall. In the lower limbs, fracture of the thigh bone (femur) and leg bone (Tibia and fibula) are common.
In children, the fracture management is simple with plaster cast (recently the fiberglass) immobilization. The healing and remodeling potential is very high. However, whenever the child is brought to us with the fracture in the upper limb or lower limb, the first question the parents ask is, whether my child will become normal as before, whether there will be any deformity and any shortening etc. The answer is very simple, if it is treated by a well-trained Orthopaedic surgeon, complications will not occur. In our village setup, many parents take their children to native bone setter and then get into complications like deformity, shortening, neurological and vascular problems.
Very commonly when the child falls from a cycle or while playing, he or she falls with the outstretched hand on the left side or right side. When this happens, the impact will be transmitted to the wrist, forearm bones, elbow, shoulder, and clavicle.
The commonest fractures which we see are the “Greenstick” fracture of forearm bones and supracondylar fracture of the humerus above the elbow joint.
Child’s bones are like a thin branch of a tree (Green Stick), hence it breaks on one side of the cortex and the other side bends. The treatment here is straightening the bone under anesthesia and giving a plaster cast for 3 weeks is sufficient. Taking care of the plaster by the parents is important. Otherwise, the bone will deform again. Very often the parents tend to take the child to the bone setter and we see a lot of complications because of the native splints. Another important factor in children fracture healing is that deformities gradually gets corrected. This may take 2 years.
Supracondylar Fracture Humerus:
This is the commonest of all elbow injuries. Whenever the child complains of pain and swelling of the elbow, X-ray must be taken to rule out any fracture. An undisplaced fracture can be treated with a plaster cast for 3 weeks. After 3 weeks, physiotherapy is important to get back the normal range of movements.
In displaced fracture, the modern method is to reduce the fracture under anesthesia and under fluoroscopic control and fix with 2 criss-cross Kirschner wires, for 3 weeks and above elbow plaster cast. After 3 weeks, the wires are removed and one more week plaster is given and exercises are started.
The physiotherapeutic measures must be done well. Otherwise, the child will develop post-traumatic stiffness.
Fractures in children are common. Parents must take all efforts to take them to the correct orthopedic surgeon who can treat better without any complications.