DOCTOR IS IN: Treating broken bones in children

By Michael Schmitz, M.D., Chief of Orthopaedics, Children’s Healthcare of Atlanta

Most broken bones (fractures) in children occur in the fall, when school and community sports are in full swing. According to the American Academy of Pediatrics, nearly 3.5 million sports-related injuries occur each year in the United States to children younger than age 14, with fractures among the most common. Fractures are the most common sports-related injury seen in the Emergency Departments at Children’s Healthcare of Atlanta.

The bones of children are different than those of adults and benefit from specialized pediatric care to promote proper healing and future growth. Some of the more common sports fractures are growth-plate, greenstick and torus fractures. A growth-plate fracture involves damage to a portion of the bone that contributes to its length and shape. In greenstick fractures, the bone bends like green wood and breaks on only one side. The bone is buckled and weakened but not completely broken with a torus fracture.

Because children’s bones heal quickly, a cast or splint may be all that is needed for a minor fracture. For a more serious injury, a pediatric orthopedic surgeon may have to realign the bones. This is a procedure in which the surgeon uses local or general anesthesia, manipulates the bones until they are straight and then either applies a cast or uses internal fixation with rods, plates and screws. Fractures that are not reduced to exact anatomic position but are within acceptable limits will mend. They heal due to a process know as remodeling.

Remodeling is the process that occurs over time as a growing child’s bone reshapes itself to an anatomic position. This is why some fractures do not have to line up perfectly when you see them on the X-rays. Remodeling will continue as the child grows for one to two years after a fracture.

A cast or splint is used to immobilize broken bones until they start to heal. Once there is enough healing to prevent the bones from moving without the cast or splint it can be removed. Fortunately, the younger the patient the more quickly the fractures heal. Your pediatric orthopaedic surgeon may order periodic X-rays while the bone is healing to make sure they are aligning properly.

To streamline fracture care, Children’s recently launched a fast-track Fracture Program in the Emergency Departments at Children’s at Egleston, Children’s at Scottish Rite and four Immediate Care locations in the metro area. This new program provides dedicated pediatric orthopaedic oversight, faster care, same site casting services (Children’s at Scottish Rite) and easier access to follow-up care with pediatric orthopaedic specialists.

The Fracture Program ensures that a team of pediatric-trained specialists work together to provide the best care possible for children who incur a fracture. From the initial visit to the last therapy session, Children’s focuses on the need of the child. Though experiencing a fracture can be painful, having it treated at a pediatric hospital can make it a little easier. With skilled physicians and a little luck, the only memory a child will have of his fracture will be a cast covered with signatures.

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