Fractures occur when a bone is subjected to excessive force (trauma) or stress. Fractures are more common in children because they are typically more active than adults. The vast majority of childhood fractures will heal uneventfully without the need for surgical intervention or prolonged immobilization or casting. However, fractures that involve the growth plates, femur, or joints such as the hip, knee, ankle, wrist, and elbow can be fairly complex and lead to prolonged healing times or permanent disability.
Fractures are primarily caused by trauma or stress but some medical conditions can make bones susceptible to fractures from minor and in some cases no injuries.
- A visible deformity, break, or misalignment
A clinical examination and x-rays are used to diagnose and assess fractures.
Early fracture management is aimed at controlling bleeding, preventing bone death, and removal of potential sources of infection such as foreign particles and dead tissue. Fractures can take several weeks or months to heal completely. Children should limit their activities until the bone becomes solid enough to bear stress. During follow-up visits, new x-rays should be taken to check progress and assess healing.
Casting alone may be sufficient in cases where the fracture is non-displaced, meaning the broken bone ends are in proper alignment and anatomic position.
Fractures and dislocations that can’t be treated by casting may be treated with traction. There are two methods of traction: skin traction and skeletal traction. Skin traction involves attachment of traction tapes to the skin of the limb segment below the fracture. Skeletal traction is most commonly used for fractures of the thighbone. A pin is inserted through the bone distal to the fracture and weights are applied to the pin. However, newer methods have resulted in traction now being rarely used.
Open Reduction and Internal Fixation (ORIF)
If a fracture is displaced it must be restored to proper positioning and immobilized. Open reduction is a surgical procedure where the fracture site is exposed and the positioning of the bone ends is corrected. The fracture is held in position with devices such as Kirschner’s wires, plates and screws, and/or intramedullary nails to achieve internal fixation. A confirmatory x-ray should be taken after reduction to ensure proper positioning of the fracture ends.
External fixation is a procedure in which stabilization of the fracture is done at a distance from the site of the fracture and the fixation device is placed outside the body. This helps to maintain bone length and alignment without casting. External fixation is performed in the following conditions:
- Open fractures with soft-tissue involvement
- Burns and soft tissue injuries
- Pelvic fractures
- Comminuted and unstable fractures
- Fractures having bony deficits
- Limb-lengthening procedures
- Fractures with infection or nonunion