Handling toddler fractures

By Erin Dym on March 26, 2013
Nikky and Brandon LaPierre were justifiably distraught when their 18-month-old daughter, Robyn, broke her leg after a simple fall. Robyn had to be rushed to the hospital and underwent an X-ray to confirm she had sustained a fracture. She ended up in a cast for three weeks – from her hip right to her toes. “I could hear the cast banging on her crib at night,” remembers Nikky. “We got a lot of interesting looks from people at the store. I wanted to say ‘she fell and it’s common!’”

Bone breaks really are common, according to Dr. Benjamin Escott, orthopedic surgery resident at the University of Toronto. “Half of boys and a third of girls will have at least one fracture during childhood,” he says. There are many reasons for this.

First, children’s bones are developing throughout childhood and do not reach their maximum stiffness and strength until early adulthood. “This means they can break with very little force, and, in some cases, bend without actually breaking (known as “green-stick” fractures). Many children’s fractures occur after a simple fall from standing height, for instance by slipping on a crayon or tripping on the sidewalk,” says Dr. Escott.

Second, children’s bones have open growth plates at each end that allow the bones to grow in length. These growth plates are made of cartilage, which is not as strong as bone. Many children’s fractures occur through these growth plates after a low-energy fall (for example, from standing height or rolling off a couch). In rare situations, the fracture through the growth plate can affect the growth of the limb and needs careful follow-up by an orthopedic surgeon.

It’s not just the bones that are developing through childhood. “The nervous system (balance and coordination) and muscles (strength) are also developing, which is why kids fall all the time,” he says.

Signs and symptom

If you suspect a fracture, Dr. Escott advises seeing a doctor who can order an X-ray and interpret the results. For most people that means a trip to an emergency room. “Symptoms to watch out for are pain, swelling and sometimes deformity of a limb,” he says. “Other things that should raise suspicion are if your child can’t put weight on their leg or is unable to use their arm after an injury. Young children may not be able to articulate their pain and may instead be irritable and have difficulty settling.”

The healing process

The time required for a fracture to heal depends on the age of the child, location and nature of the injury. Legs are casted longer than arms because they need to be strong enough to stand on. Older children need casts for longer periods because their injuries are usually more severe and their bones take longer to heal. In general, most broken bones are placed in a cast for somewhere between three and six weeks.

“I tell parents that bones need about three months before they are completely healed and as strong as they were before the fracture,” says Dr. Escott. He suggests that kids can return to most activities after six to eight weeks, but are advised to avoid high-risk activities until three months have elapsed to reduce the risk of re-injuring the fracture.

“Overall, kids’ fractures are relatively straightforward injuries that heal quickly with little or no long-term effects,” he says.

Two months following Robyn’s fall, she was walking, running and climbing normally. As for her parents, they are back to holding their breath every time their daughter slips and falls, or trips over a crayon!

Cast care

Dr. Benjamin Escott has these tips for dealing with a child in a cast:

Watch for signs that the cast might be too tight and call the doctor if any of the following develops:
• increasing pain (especially with movement of the fingers/toes)
• numbness in the fingers/ toes
• cold/pale/blue toes
• inability to move fingers/ toes

Keep casts clean and dry. Most casts are applied with a soft cotton underpadding that absorbs water and will not dry if it gets wet, causing irritation and skin breakdown, not to mention a very stinky smell. Plastic bags can be applied over a cast with a tight tape/elastic seal to prevent the cast from getting wet during baths or showers. Special casts that combine a water-resistant synthetic underpadding with fibreglass overwrap are available (for a fee), and can be worn in the shower, in a pool or even the ocean.

Do not stick anything down a cast to scratch an itch. Two bad things can happen. First, the device (pencil, hanger, etc.) can scratch the skin, causing increased pain or infection. Second, the device may get stuck in the cast and become irretrievable. This can cause pain and skin breakdown.

Make the cast fun.
• Let your child choose a fun colour if a fibreglass cast is an option (try stripes or glow-in-the-dark)
• Get autographs from family and friends and rurn the cast into a work of art.
• Encourage activity. Just because your child can’t run or hang from the monkey bars doesn’t mean you can’t have fun in other ways.

Originally published in ParentsCanada magazine, April 2013.

By Erin Dym | March 26, 2013

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