There are 206 bones in the human body and all of them can break. Some are more vulnerable than others, but when a child gets injured and complains of pain in a finger, toe, arm or leg, the possibility of a broken bone creates a huge dilemma for parents. Most want to know: (1) how can I tell if it’s broken and (2) should we go to the emergency department? The answer to the first question is that it isn’t always obvious-even to a doctor-which is why the answer to the second question is almost always yes.
A broken bone is also called a fracture. Fractures can cause swelling, tenderness and pain, but small breaks can be subtle and sometimes a child will not complain much. If you think your child has a fracture, it’s reasonable to go to an emergency department to get it checked out. On the other hand, if your child is calm and comfortable you can take some deep breaths and call your pediatrician for guidance.
The best way to be sure about whether a bone is broken is to get an X-ray. It’s painless and effective, but even an X-ray can miss a very small fracture. If the doctor has a high suspicion of a fracture, even if it isn’t visible on the X-ray, a cast will usually be applied and the bone will be X-rayed again in a few days to check for signs of healing.
In most cases, a fracture isn’t going to cause immediate harm, but sometimes it creates an obvious deformity and, in more severe cases, a part of the bone can even break through the skin. These are true emergencies and the child should be sent by ambulance to the nearest emergency department. Fortunately, that’s pretty uncommon.
The treatment of fractures can vary widely, depending on the severity and location of the break. In general, the goal of treating a fracture is to make sure the bones are “aligned” (which means they are in the same general position they were in before the fracture) and held still (immobilized) so they can heal properly.
Limiting bone movement will also help reduce the pain, but oral pain medications should be used as needed.
In some cases, a simple splint can be used to immobilize a fracture. In other cases, a cast is needed. Sometimes a very big cast is needed for a very small fracture because the bones above and below the break must also be held still. Rarely, a child will need an operation to correct the break.
It’s important to mention that none of these methods has healing properties; they just hold the bones very still while the body naturally mends the injury. The early stages of bone healing happen in four to six weeks and at that point the cast is removed. Even though early bone healing happens fast, the fracture isn’t completely healed for more than a year.
The vast majority of broken bones heal well and without complications, but in rare cases fractures can cause long-term problems. Some breaks can cause damage to the growth center of the bone, which leads to “growth arrest” and an obvious difference in the length of one leg compared to the other. Sometimes bones don’t mend correctly or at all and need an operation to help the process along.
Dr. Lisa Thornton, a mother of three, is director of pediatric rehabilitation at Schwab Rehabilitation Hospital and LaRabida Children’s Hospital. She also is assistant professor of pediatrics at the University of Chicago. E-mail her at drlisathornton@gmail.com.
