Welcome to kidsfractures.com, a website for answers to the most common questions about pediatric fractures. This website was written by two orthopedics surgeons interested in making the experience of families with a child who has a broken bone a little less traumatic.
This is a list of the fractures that are described in this website, with quick links to the relevant pages:
- collar bone
- upper arm (humerus)
- lateral epicondyle fracture
- upper leg bone (femur)
- lower leg bone (tibia)
- pediatric sports medicine
- fractures associated with child abuse
The most important concept to get out of this site is that of FRACTURE REMODELING. Pediatric fractures are different than adult fractures. Kids have a remarkable ability to correct the angulation and bends caused by broken bones through further growth. We have a saying — your child’s DNA wants to have straight bones — and as an example, here is a picture gallery of the way that a severe tibia fracture in a child heals over time and the bone remodels itself. This fact is used by treating orthopedic surgeons to avoid surgery in children, because with an appropriate knowledge of the natural history of fractures it is possible to treat certain fractures in a cast that may seem like they need to go to the operating room. This is not always the case, but in certain instances, if the risks of anesthesia and an operation can be avoided, and the fracture can be treated in a cast with good results, then everyone is happier.
This is a typical case that illustrates the process of fracture healing and remodeling. This is a 4 year old rambunctious male who came to the emergency department on a friday night with this injury….(you can click on any one of these pictures to see a larger version of the picture)
He has a fracture of the distal radius and ulna with posterior angulation of the fracture, significant displacement, and the fracture in this state is in unacceptable alignment. The child was given an anesthetic in the emergency department and the fracture was manipulated back into position. One week later, the child was seen in clinic, and the fracture looked like this…..
Here the fracture is in acceptable alignment. While the fracture is still somewhat angulated, the overall alignment of the limb is considered satisfactory for a 4 year old child with a lot of growth remaining.
In these two pictures, you can see how there has been a bit more “drift” of the fracture during the 4 weeks that the cast was on, but the bone has started to fill in like a snow drift across the fracture site. 4 weeks after the initial break, the cast was removed. The arm looked very slightly bent, but not enough to cause the mother any undue concern. Six months later, the child was brought back to clinic for one final xray check and here is the final result:
With these two pictures you can see how the fracture lines are barely distinguishable and as the bone has continued to remodel the deformity lessens and the arm grows straighter and straighter. At this point, only six months after the break, it was already hard to tell which side had been broken.
Another example of fracture remodeling….
In the following example, we present the xrays of a tibia fracture that was initially treated with an external fixator. This was a very severe fracture, and these pictures have been chosen because they demonstrate how the biology of the bone is able to overcome the initial displacement and fragmentation (what we call comminution) at the fracture site, and with time, recreate a smooth bone that looks normal.
This is a lateral xray of a severe tibia fracture at the time of injury after an external fixator has been applied. Notice how the ends of the bone are jagged and the fracture is in many pieces.
This is the same fracture after the external fixator has been removed. Notice how the ends of the bone a less distinct, there is callus (healing bone) bridging the fracture site, and the bone is starting to fill in.
Here, the fracture has completed healed (though you can still see the holes from where the external fixator was applied) and the bone is starting to remodel. In another year, it will be difficult to tell that the bone was ever broken,
After you finish looking at this series of pictures, browse through the menu items on the right side, looking for topics that interest you.
If you have any questions, comments, or especially if you want to tell us about a particular fracture or send us some pictures to publish, email us @ firstname.lastname@example.org