Paediatric Trauma

Stress fracture: a tiny crack in the boneComminuted fracture: a bone breaks into more than two piecesUsually, the injured part will be swollen and child will have pain around the injured limb and there could be an obvious deformity (angulation) or bruising seen at the injured level which denotes there is a fracture. Child will have difficulty in moving the injured limb or will resist any attempt to do so. There could be some bruising or redness in the area in case of closed injuries and bleeding wounds in case of open injuries.

Types of bone fractures include:

• Greenstick fracture: a break on one side of the bone only
• Buckle or torus fracture: an outward bend on one side of the bone without breaking the other side
• Avulsion fracture: when a tendon or ligament pulls off of a tiny piece of bone
• Growth plate fracture: a break in the area of a child or teen's growing bone
• Comminuted fracture: a bone breaks into more than two pieces
• Compression fracture: a collapsing of the bone
  

Closed upper limb injuries

• Clavicle fractures
• Proximal humerus fractures
• Humerus shaft fractures
• Fractures around the elbow
• Monteggia fracture dislocations
• Forearm (Radius and ulna) fractures
• Fractures around the wrist (Distal radius and ulna) fractures

Clavicle

Clavicle or the collar bone is one of the main bones in the shoulder and fracture of the clavicle is one of the common fractures (broken bones in children). Children usually get injured by falling on an outstretched hand while playing. Kids may have a swelling around the collar bone and the child may have restricted shoulder movements on the affected side. It can be diagnosed with X-rays. Usually, these fractures are managed with an arm sling with rest for 3 to 4 weeks

Elbow fractures

Pediatric elbow fractures are usually the result of an impact injury, like in a direct blow, or when a child uses his outstretched arm to break a fall. The common symptoms are

• Pain or swelling in the elbow or forearm
• An obvious deformity in the elbow or forearm
• Difficulty moving, flexing, or extending the arm normally
• Warmth, bruising, or redness at or near the elbow

The common fractures around the elbow are:

Supracondylar fracture

The most common type of elbow fracture in children. Happens due to fall in out stretched hands. Sometimes the displacement is very severe that some of these fractures are associated with vascular and nerve injuries. When the fracture is not much displaced, they can be managed with plaster cast and when associated with severe displacement or with injury to nerve or blood vessels, your child may need surgical intervention and fixation to aid union in a good position. Generally, it takes 4-6 weeks for the fracture to unite well and removal of the plaster or the wires. In case of inadequate treatment there may be complications like malunion and deformity.

Lateral condyle fractures

Lateral condyle fractures are fracture happening on the outer aspect of the arm bone (humerus). Usually, this fracture is little difficult to diagnose as many times they may be easily missed in the initial x-rays. Our doctors may ask for special view x-rays which may show the fracture or sometimes you may need an MRI. These fractures are prone to get complicated. They can be treated in a plaster when minimally displaced and needs surgical intervention when displaced.

Medial epicondyle fractures

These fractures are seen in association with elbow dislocation and is seen mostly in elderly children. Most of these fractures are managed in a plaster for three weeks when the elbow joint is stable. But in unstable elbow joints or displaced fractures it is fixed with a screw by surgery. 

Radial neck fractures

This is the fracture of the upper end of the outer bone of the forearm. This fracture happens following a fall on the outstretched hand and most of these fractures are treated in a plaster unless they are displaced which needs surgical intervention.

Olecranaon fractures

These fractures are those that happen at the upper end of the inner bone in the forearm. Some of these fractures may be associated with elbow dislocations and instability. And hence most of these fractures are treated by surgery when they are displaced. When it occurs in younger children, it may not be easily found as this part of bone takes 9- 10 years to be seen clearly in x-rays.

Fractures of the forearm

Fractures of the forearm in children are one of the most common fractures and they usually occur after an accidental fall while playing and following a fall on the outstretched hand. It happens in either or both the bones of the forearm namely radius (outer bone) and ulna (inner bone). Most of these fractures can be managed in a plaster cast for 4-6 weeks duration except in the fractures which happen in older children.  The fractures around the lower end of the forearm near the wrist are most commonly treated with plaster and in some children when the fractures is involving the growth plate of the forearm bones (radius and ulna) as these fractures involving the growth plates may result in abnormal deformities when not treated properly

Closed lower limb injuries

• Fractures around the hip
• Thigh bone (Femur) bone fracture
• Fractures around knee
• Leg bones (Tibia and fibula) fracture
• Fractures around the ankle

Femur bone fractures

Femur also called as the thigh bone is the longest bone in the body and it and forms the hip joint above and knee joint below which altogether is an important for walking and standing. Children while playing get injured to the thigh bone easily and this fracture when it occurs it is treated by plaster spica in young children upto 5 years of age and by surgical fixation in older children. when this fracture happens at the upper end of the bone it is treated as an emergency procedure by surgical fixation. And when it happens in the lower end of the thigh bone around the knee joint, most of these fractures occur in the growth plate of the thigh bone and this must be treated appropriately otherwise may result in the abnormal bending(deformity) of the bone due to altered growth after growth plates injuries

Fractures of the leg

Both these are connected together strongly by ligaments and they form the knee joint in the upper end and ankle joint in the lower end. Fracture of the bones in the leg involves fracture of either the tibia or fibula. The fracture involving the upper end of tibia and fibula may involve the growth plates occasionally and needs surgical intervention. The fractures of the tibia or the shin bone in the middle part can mostly treated with a plaster cast for a period of 4-8 weeks duration. When the fracture is near the lower end it may involve the ankle joint or may have some specific special type of fractures called triplane fractures which occurs in different planes.

Many children get admitted with fractures associated with skin lacerations (wounds in the skin) which are called compound or open fractures who needs immediate debridement and some may have multiple injuries affecting various organs like brain and chest (polytrauma) who will need staged management and multiple procedures at times

Treatment options depends on the type of fracture, your child’s age and health and any other associated injuries. Our team of Paediatric Orthopaedic Specialists will let you know after detail assessment of your child.

Common management methods

• Conservative management and casting
• Surgery - Internal fixation and External fixation

Our paediatric orthopaedic specialist will explain to you about the need for Your child will to keep the broken bone from moving so that it can heal which can be done by casting methods or by using hardware like pins, rods plates and nails. This will reduce damage to the tissue around the broken bone, including nearby blood vessels and nerves.

Casting is a procedure we do for treating an undisplaced and minimally displaced fractures of the forearm, arm, thigh and leg bones in younger children. A cast holds a broken bone in place and prevents the area around it from moving as it heals. Casts also help prevent or decrease muscle contractions and help keep the injured area immobile, especially after surgery, which can also help decrease pain. Cotton and other synthetic materials are used to line the inside of the cast to make it soft and provide padding around bony areas, such as the ankle, wrist, or elbow. The hard, outer layer of a cast is made of either plaster of Paris or fiberglass plaster. The regular plaster with Plaster of Paris will be white in colour and should be kept dry without spilling of water all the time. Fiberglass casts are more lightweight and stronger, durable than plaster of Paris casts. They come in different colours.

Our team of doctors take appropriate care in applying the plaster. Usually, we do it as an outpatient basis, and when it is necessary for manipulation, we take appropriate care to make the child and their parents feel comfortable about the procedure and we do it under anaesthesia. Sometimes, your child might need to get admitted for a day in case of procedures done under anaesthesia. All children will be followed up weekly and fortnightly with x-rays till the fracture unites well. Children can return back to their regular activities by 4-8 weeks duration.

Whenever a long or short arm cast is applied, it is better to use an arm pouch to make your child comfortable. When a short leg or long leg cast is applied, your child may be advised to walk with crutches or walker. You need to follow certain precautions when your child is treated in a plaster (cast care).

Cast care

• Keep the cast clean and dry. The best way to keep a cast dry when bathing is to put two bags over the cast. Place a bag on the cast, then apply a towel around the top of the cast with tape, followed by the second bag. This does not make the cast waterproof, but it will help protect it from splashing. If the cast does get splashed on, you can use a hairdryer to dry it. If the cast gets very wet you will need to have the cast changed as the moisture can damage the skin underneath the cast.
• Check the cast often for cracks or breaks.
• Cover the cast while eating to prevent food spills and food particles from entering the cast.

Skin care

• Children should not scratch the skin under the cast by inserting objects or fingers inside the cast.
• Children should not put small toys or objects inside the cast.
• Children should avoid sand, dirt, and mud which can irritate child’s skin.
• Do not rub ointments inside the cast. 

General care

• Elevate the cast above heart level to decrease swelling.
• Encourage your child to move their fingers or toes to promote circulation.

Caring for a body cast

Older children with body casts may need to use a bedpan or urinal in order to go to the bathroom. The following tips will help keep the body cast clean and dry and prevent skin irritation:

• Keep the genital area as clean and dry. 
• Use a diaper around the genital area to prevent splashing of urine and soiling of cast.

If your child’s cast has gotten wet, please contact us. Unless your child has a waterproof cast, a wet cast can lead to complications.  The cast may need to be removed or changed to avoid complications. Our doctors will let you know what to do after seeing the condition of the plaster. Your child may be seen in the emergency department also for this.

Contact us if your child develops one or more of the following symptoms

• Fever
• Increased pain
• Increased swelling above or below the cast
• Complaints of numbness or tingling
• Drainage or foul odor from the cast
• When you notice paleness in the fingers or toes