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Plymouth Paediatric Orthopaedics

General

Fractures occur when a force is applied to a bone. Like all materials, bone has a limit to how much force it can withstand and if the force applied is greater than the bone’s limit, it will break.

Children’s bone is growing and as a result, the fractures we see in children are different to adult fractures. A child’s bone is a like a growing branch on a tree - smaller and more flexible. This is where the term “greenstick” fracture comes from. If you snap a growing branch of a tree, it will bend much more before it breaks, and when it does, the bark around the wood is tough and flexible. In bone this is called the periosteum. Periosteum covers the bone, delivers nutrients to it, and so is important in fracture healing.

If a fracture is “displaced”, it means that the ends of the fracture are not perfectly aligned. As children’s bone is growing, it has the ability to remodel itself. This means that even if a fracture heals with a slight deformity, over time it will correct itself. Generally speaking, younger children have a lot more growth potential and will remodel more than older children. As a result, we can accept a certain degree of deformity, as we know it will remodel over time.

Once bone is fully healed, it is as strong as before. Whilst the bone is healing however, it is advisable to take common sense precautions, such as avoiding contact sports. Young children heal very quickly. How long you spend in a cast depends on your age and type of fracture.

“Growth plates” are unique to children’s bones and are the sites where the bone is growing, located at each end. The growth plate is made of cartilage, which later turns into bone. Fractures often occur around the growth plate, as the cartilage is weaker than the surrounding bone. Fractures around the growth plate that are displaced often require an operation, in order to allow normal growth. We follow up these children until we can be sure that their growth is normal.

When a fracture is diagnosed, the limb will usually be temporarily splinted. We often use a back slab (half a plaster cast), which allows for swelling. Most children will then be sent home, with a follow-up appointment for the fracture clinic. It is important to elevate the limb, and if necessary simple painkillers bought over the counter are usually enough to settle any discomfort.

If your child requires an operation, they may need to be admitted to our paediatric ward, or more commonly asked to come back within a few days directly to Plym children’s theatres. Surgery is usually only required for severe fractures, fractures that involve the joint surface or the growth plate and open fractures.