A bone fracture is a medical condition in which a bone is cracked or broken. It is a break in the continuity of the bone. While many fractures are the result of high force impact or stress, bone fracture can also occur as a result of certain medical conditions that weaken the bones, such as osteoporosis.
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Fractures are more common in children due to their activities as well as their bone properties. Children are more active than adults and management of fractures in them also differs as compared to that in adults. Fracture occurs when the bone is subjected to excessive stress than normal. It is very common in children because of the presence of growth plate which is the area of the child’s bone that consists of cartilage cells that transform into solid bone as the child grows. Growth plate fractures occur more often because it is the weakest area in the bone.
Children with growth plate fracture may complain of pain and localized tenderness over the growth plate. There may or may not be any swelling or an obvious deformity. Clinical examination and X-rays will be required for diagnosis of a growth plate fracture.
Once your doctor has confirmed the diagnosis of growth plate fracture, the treatment options will be discussed. If there is a non-displaced fracture in which the broken bone ends remain aligned in correct anatomic position, then casting is the treatment option. A reduction will be necessary if the fracture is displaced and is done under local or general anesthesia. A confirmatory X-ray will be taken to ensure correct positioning of the fracture ends after reduction. In certain cases, surgery may be required to reposition the growth plate fracture into healing position.
Your doctor will schedule a follow-up visit after few months during which X-rays will be taken to check for normal bone growth. If any growth disturbance or deformity is detected, further treatment becomes necessary.
Early fracture management aims at controlling bleeding, preventing ischemic injury (bone death) and removal of sources of infection such as foreign bodies and dead tissues. The next step in fracture management is the reduction of the fracture and its maintenance. It is important to ensure that the involved part of the body returns to its function after fracture heals. To achieve this, maintenance of fracture reduction with immobilization technique is done by either non-operative or surgical method.
Non-operative (closed) therapy comprises of casting.
Closed reduction is done for any fracture that is displaced, shortened, or angulated. Splints and casts made up of fiberglass or plaster of Paris material are used to immobilize the limb.
This is a surgical procedure in which the fracture site is adequately exposed and reduction of fracture is done. Internal fixation is done with devices such as Kirschner wires, plates and screws, and intramedullary nails.
External fixation is a procedure in which the fracture stabilization is done at a distance from the site of fracture. It helps to maintain bone length and alignment without casting.
External fixation is performed in the following conditions:
Fractures may take several weeks to months to heal completely. Children should limit their activities even after the removal of cast or brace so that the bone become solid enough to bear the stress.