Signs of a fracture
Broken bones are most common in the upper and lower extremities (limbs). The upper extremities include the arms, elbows, wrists and fingers and the lower extremities include the legs, knees, ankles and feet. Tendon and ligament injuries (sprains and strains) can occur in these areas as well, but do not occur as frequently in children.
If your child has an extremity injury, there are a few ways to determine if your child needs to be seen immediately or if it can wait until later. Some symptoms may seem obvious; others may not. The general signs of a fracture are:
- Swelling with tenderness over the area involved
If the child or adult heard a snap or grinding sound when the injury occurred, it is more likely to be a fracture, but not necessarily.
When to seek care and how to help
A child should be seen ASAP if:
- The extremity has a deformity (may look like a bump or change in shape around the bone).
- There is a break in the skin and bone is showing.
- The child cannot bear weight on or use the extremity 15 minutes after the injury occurred
- The child’s pain is not being controlled and the child is crying with rest, elevation, ice and over-the-counter pain medication.
If ANY of these things are true seek medical attention immediately and do not allow the child to eat in case surgery or a procedure to align the fracture is needed. If there is severe bleeding, a break in the skin or a question of a spinal injury, call for emergency care.
If the extremity appears deformed, clothing should be carefully removed or cut from the injured limb and the limb should be supported with a makeshift splint. A makeshift splint can be made with some soft padding around the injury and something firm extending beyond the joints above and below the injury. The American Academy of Pediatrics recommends wrapping a small board, cardboard or folded up newspapers with an elastic bandage or tape to make a temporary splint. (For more on splinting an injury, see pages 41-45 of the American Red Cross Babysitter’s Training Guide.)
If all of the above things are negative and the extremity is not very swollen, then the child can potentially wait to see a physician in an outpatient clinic to have an exam and get x-rays if needed. To reduce swelling, you can apply cold compresses or ice wrapped in cloth, a towel or other material, but do not apply ice directly to the skin as this could cause frostbite (freezing of the skin and underlying tissues).
Most broken bones will be recognized immediately or within a day if a child is still not able to use the extremity as usual. If after a day this is the case, the child should be seen in an outpatient clinic, either with the primary care doctor or an orthopaedic surgeon. Although many children are not able to tell us exactly where this type of injury is, they usually will protect that extremity or cry when it is touched, which is another sign that a child may need medical care.
Sometimes x-rays will not show a fracture if it is through the growth plate and the child will still be treated for a fracture if there is enough suspicion. Growth plates are cartilage and do not show up on x-ray. Therefore a fracture through the growth plate that has not moved or shifted will not show on the x-ray. These are minor fractures, but still may need to be immobilized for symptoms and to protect the child from doing more harm.
To learn more about ankle, elbow, femur, forearm or growth plate injuries and how each are treated, see the “I Broke My…” section of the Pediatric Orthopaedic Society of North America website.
Disclosure: This article is solely dealing with extremity injuries and not multiple traumas including possible abdominal or head injuries. If any of those are suspected, seek medical attention immediately. Do not move the child if there is suspected neck or spine injury.