All about Sprain, a Dislocation and Fracture in Children

I had once read that the years between the age of 3 to 7 is known as the ‘ouch’ years. I can validate this statement as I hear my 4 year old saying an ‘ouch’ every few minutes as she keeps getting hurt. Thankfully she has not broken any bones yet, but I would like to be prepared and know what to do if an accident results in a fracture. Toddlers and older children are constantly getting bumps and bruises. Exploring the world around them and trying out new things can sometimes result in physical injury and one hard fall can result in a fracture!
One out of 5 people have had a fracture in their lives and most of them had it during their childhood. I remember falling down the staircase and fracturing my left elbow at the age of 8 years. Two months of wearing a cast and the effort thereafter to get the strength back in my hand, made me cautious child.

A Fracture or a Sprain?

The pain associated with a sprain is less intensive than a fracture. But it may be unbearable for a child. It is always advisable to let a doctor have a look to administer the correct treatment.
What is a dislocation?
A friend of mine also an enthusiast trekker had taken their 3 year old toddler for his first hiking experience along a beautiful mountain route. After a 3 hour hike, the little boy had a fall and his left elbow seemed to have broken. His lower arm was dangling and he could not move it. My friend and her husband rushed him to the hospital. Fortunately it was a dislocation and the doctor simply knocked the elbow bone into its place and almost immediately he regained control of his hand. To my friend, it looked like a severely fractured elbow.
As we see, from this instance that a dislocation occurs when the bone comes out of its socket. This results in severe pain, swelling and inability to move the injured part of the body.

What is a fracture?

A fracture is a partial or complete break in the bone.
The following are some of the popular fractures:
• A Complete Fracture: When the bone has broken into two pieces.
• Green Stick Fracture: When the bone breaks only on one side and not all the way through.
• A Comminuted Fracture: When a bone breaks in more than two pieces or is crushed. This type of fracture usually requires surgery.
• Hairline/ Stress Fracture: Tiny cracks on bones without the separation of fragments. This often results in repeated strain. This type of fracture is often seen in children who dance.
• Bowling fracture: Common only in children, where in the bone only bends and does not break or crack.
• Open Fracture: When the broken bone breaks through the skin.

Symptoms of a fracture:

1. Severe pain, swelling and tenderness in and around the injured area.
2. Difficulty in moving the injured part of the body.
3. Bruising or redness in the area.
4. A clear deformity in the injured area.

What to do if you suspect a fracture, a sprain or a dislocation?

• If your child has had an accident that caused an open fracture, where the bone has pierced through the skin, you may want to take him/her to nearest hospital immediately. This type of fracture is the most dangerous considering the risk of bleeding and infection. It is best not to touch or even breathe on a fracture such as this. You may cover the wound with sterile gauze and rush to the hospital.
• If the fracture is not as severe as an open fracture, then you may call the paediatrician for advice. The doctor may recommend an x-ray and a follow up visit.
• To make your child comfortable, you may give him/her children’s pain relief medications to help relief the pain.
• You may use some ice compress to reduce swelling. An ice pack can be made by wrapping a few cubes of ice in a cloth. Holding the ice pack against the injured area for 15-20 minutes at a time, may help reduce swelling.
• No form of heat treatment should be given.
• Massaging the affected limb should be avoided.
• After using ice pack, you may wrap a bandage around the injured area to reduce swelling. To make sure the bandage is not too tight, check by inserting a finger between the bandage and the skin.
• Elevating the injured hand or leg (by raising the leg on supports while lying down) above the level of the heart, will also help bring down swelling and reduce pain. You may want to make the child lie down and place a pillow under the injured limb.
• You may try to immobilize the area by supporting it with a temporary splint. A splint may be made at home with everyday objects such as a magazine, a piece of cardboard, a ruler, a soft cloth etc. To support a fractured joint, you may wrap the joint with a magazine or a cardboard. Placing a piece of soft cloth first and protecting the skin to provide with some padding is ideal. You may then use shoelaces, ties, handkerchiefs to hold the temporary splint in its place.
• For a fractured finger, one could place a piece of cloth or cotton between the injured finger and the finger next to it. Finally taping the fingers together does the trick.

What is the procedure to treat a fracture by a professional?
The doctor will do an x-ray to determine the extent of damage. If the damage is severe, such as the bones are out of line, then an orthopaedic surgeon may be consulted and the necessary treatment carried out.

A few facts about fractures in children:

1. Fractures in children heal faster as they are more flexible than that of an adult.
2. Bones in children have a thicker covering known as Periosteum, which is responsible for easy healing by restoring the broken bone. This covering gradually wears thin with age.
3. The most common fracture is that to the wrist bone as we instinctively tend to put our hands forwards to protect ourselves during a fall.
4. A child’s broken thigh bone takes about 6 weeks to heal as compared to 20 weeks for an adult and 2 weeks for a baby.
5. Fractures in children rarely require surgery. Treatment usually involves keeping the bone rested with the use of a cast.
6. Since a child’s bones are still growing, any fracture may affect the growth plates at the end of the injured bone. This may affect the child’s future growth. Any undesired changes may not be visible until a year or more after the fracture. Hence a follow up check up after 12 to 18 months is necessary to rule out any damage to the growth of the bone.
7. Children often bend their bones without breaking them.
8. Nearly half of a child’s bone mass is formed by the age of 10. A diet rich in 500 to 800 milligrams of calcium per day helps boost bone strength.
To know more about how to boost your child’s bone health, take a look at one of our earlier blogs on Bone Health in Children.

An easy way to know what to do if any of the above are suspected is to remember RICE- Rest, Ice, Compress, and Elevation.