Management of Toddler's Fracture

Introduction

Fracture is complete or partial breakage of the bone. It occurs due to force applied to bone beyond the bone. A toddler fracture mainly occurs due to a fall or accident. Children are more prone to fractures because of their growing age, development, the density of the bone, and the remodeling process. If the broken bone penetrates the skin surface, the fracture is compound type. The most common type of fracture in a toddler is seen in the wrist, forearm, and above the elbow.

What Are the Types of Pediatric Fractures?

Following are the types of fractures seen in children.

• Compound Fracture: It is also known as an open fracture. In this type of fracture, the pieces of bone penetrate the skin surface. As a result, a deep wound in the skin will clinically expose the bone.

• Closed Fracture: It is also known as a simple fracture. There is the absence of a wound on the skin surface of the child.

• Torus Fracture: It is also known as a buckle fracture. There is the presence of outward bending of one side of the bone. The other side remains unaffected. It is caused due to longitudinal force applied along the axis of the affected region.

• Greenstick Fracture: In this type, instead of complete breakage, the bone bends and cracks into multiple separate pieces. There is a fracture in the long bone that does not extend the whole surface of the bone.

• Avulsion Fracture: This fracture is caused by a tendon and ligament being pulled off.

• Comminuted Fracture: In this type of fracture, bone is broken into more than two fragments. It is commonly caused due to the presence of high-energy trauma.

• Growth Plate Fracture: In this type of fracture, there is a breakage in the growing part of the bone.

• Collapsing Fracture: It is caused due to collapse, and the bone is broken into multiple pieces.

• Stress Fracture: There is the presence of a tiny crack in a long bone, and it is caused by stress.

• Transverse Fracture: It is caused when the force is applied on the longitudinal axis of the bone.

• Oblique Fracture: It is caused due to the presence of circumferential pressure around the fracture site.

• Spiral Fracture: It is caused by torsional force. The periosteum is left intact.

• Butterfly Fracture: It is caused by longitudinal and perpendicular forces producing this fracture.

What Are the Causes of Pediatric Fractures?

The fracture is caused due to excessive force beyond the withstanding capacity of the bone. Following are the various causes of pathologic fracture.

• Accidental trauma.

• Injuries due to Fall.

• A direct hit to the body.

• Damage due to sports.

• Traffic accidents.

• Vitamin D deficiency in children makes the bone fragile.

What Are the Clinical Features of Pediatric Fractures?

Following are the signs and symptoms of a pediatric fracture.

• Presence of pain in affected regions.

• Presence of swelling in the affected region.

• Presence of deformity of the bone.

• The temperature of the affected skin surface is raised.

• Presence of redness.

• Bruising.

• The child is unable to move the bone in the usual way.

How Is Pediatric Fracture Diagnosed?

During the physical examination, the doctor assesses the injury and the child's health status.

Following are the various diagnostic tests used to diagnose a child's fracture.

1. X-Ray: It helps in the examination of a broken bone. X-ray helps in determining the extent of damage and locating fractures or abnormalities within the bone structure..

2. Magnetic Resonance Imaging (MRI): It analyzes the detailed image of internal organs and structures within the body.

3. Computed Tomography (CT) Scan: It helps examine details of the bone muscles and organs. It uses X-rays and a computer for detailed image processing of the internal organs.

How Is Pediatric Fracture Treated?

Following is the goal of treatment in pediatric fractures.

• To reduce the fracture by open and closed methods.

• To maintain fracture reduction with the help of casts, splints, traction, and fixation.

• Achievement of anatomic reduction.

• Protection of the soft tissue.

• To facilitate the healing of the fracture.

• To permit the movement of the joint.

• Avoid complications such as malunion, infection, nonunion, premature closure of the physical end, and joint stiffness.

Following are the treatment plans for pediatric fractures.

Splinting - Splint and cast are indicated to keep the broken bone in its place during the healing process.

Medication - Analgesic is given to the child to relieve pain.

Reduction - This is done to place the broken bone in its original position with the help of cast braces and splints. This procedure helps in the setting of the bone. It avoids the movement of broken bones during the healing process. The reduction is of two types.

1. Open Reduction - In this type of reduction, surgery is performed. The incision is made, and the bone is placed in its anatomical position. Surgical plates, wires, and screws are used.

2. Closed Reduction - In this type of reduction, the bone is moved back to its anatomical position without any surgical incision. The medication is given to the child to ease the pain.

Traction - The muscles and tendons are gently stretched around the broken bone to allow the end of the bone to heal correctly. Pulley weight and strings are used in this process.

How to Provide Care for a Child With a Toddler’s Fracture?

The child should be evaluated in the orthopedic clinic within one week of the injury. An X-ray is not necessary at that visit. The leg should be protected by wearing a special boot known as a CAM (controlled ankle motion) boot or a walking boot. The boot must be removed to inspect the skin at least once a day, preferably during bedtime or bath time.

Check for any signs of skin issues such as redness, blisters, bruising, or openings. If any of these are observed, it could be due to the boot being either too loose or too tight. Stop using the boot until further instructions are received from the care team. A clinic visit will be required to assess the fit of the boot and examine the skin. The child is not required to sleep in the boot.

When to Seek Medical Care?

In the event of any of these occurrences after leaving the hospital or urgent care, return the child to the location where they were treated or contact the child’s orthopedic provider:

• Numbness or tingling in the toes.

• Bluish-purple color or cold sensation in the toes, which does not improve when the foot is elevated above the heart level.

• The toes fail to regain their pink color within 3 seconds after pressing the toenails.

• Excessive swelling accompanied by discomfort.

• The inability of the child to move their toes due to severe pain.

Conclusion

Injuries are joint events in childhood. The child is prone to broken bones and injuries due to various activities such as sports. Proper diagnosis and better treatment plans have evolved in managing childhood fractures. A child with a fracture may have painful swelling and difficulty moving the affected region. Parents should adequately observe the signs and symptoms of the child and seek treatment as early as possible. Parents should understand the treatment plan appropriately and maintain follow-up appointments. The proper treatment helps perfectly heal the bone. Parents should follow the instructions and recommendations of the pediatrician.