Children's fractures: why they heal differently

Children’s bones are softer, more bendy and still growing. They tend to bend or buckle rather than snap, they heal much faster than adult bones, and they can slowly straighten themselves as they grow. But a break through a growth plate can affect how the bone grows, so children’s fractures need prompt care and careful follow-up.

What makes a child’s bone different

A child’s bone is more flexible than an adult’s, and it is still growing. Near each end of a long bone, such as the forearm or thigh bone, there is a growth plate: a disc of cartilage where new bone is made. Growth plates are the last part of the bone to harden, so they are a weak point. When a child stops growing, the plates turn into solid bone.

These differences change three things: how the bone breaks, how fast it heals, and what can go wrong.

How children’s bones break

Because the bone bends, children get types of fracture adults rarely do:

• Buckle (torus) fracture. One side of the bone squashes and bulges. It is stable and common at the wrist.
• Greenstick fracture. The bone cracks part of the way through and bends on the other side, like a green twig.
• Growth plate fracture. The break runs through or across the growth plate.

Forearm fractures account for up to half of all childhood fractures, and most happen at the wrist end of the radius. The usual cause is a fall on an outstretched hand at play, on a trampoline, on a scooter or in sport.

Why they heal faster

A child’s bone heals more quickly than an adult’s. A buckle fracture may need only 3 to 4 weeks in a cast or splint. Many breaks that take months in an adult are healed in weeks in a child.

Fast healing has a downside. If the bone is out of place, it can set in the wrong position within a week or two. That is why children with a possible fracture should be seen quickly, before healing begins, and why repeat X-rays in the first weeks are common.

Growing straight again

A growing bone can reshape itself over time. A small angle near the end of a bone may slowly straighten as the child grows, which is called remodelling. Because of this, some children’s fractures that look crooked on an X-ray do not need to be pushed back into place. Not every angle will correct itself. How much a bone can straighten depends on the child’s age, the bone and the size of the angle, so the doctor decides case by case.

The growth plate: why it matters

Growth plate fractures happen about twice as often in boys as in girls, and are most common in the teenage years. Most heal well with no lasting effect. Rarely, a bony bridge forms across the plate. That can slow the growth of the bone or make it curve. Sometimes an injury speeds up growth, so one limb ends up longer.

Problems are more likely with some bones and some patterns, for example around the knee. These children are followed for at least a year, and sometimes until they stop growing. If a problem is found early, it can often be treated with a smaller operation.

How children’s fractures are treated

A cast or splint

Many fractures need only a cast or splint while they heal. Stable buckle fractures may need a removable splint. The child then has follow-up X-rays to check the bone stays in line.

Setting the bone

If the bone is angled, the doctor may push it back into position without a cut, under sedation or anaesthetic. This is called a closed reduction. A cast then holds it.

Surgery

Surgery is needed when the bone breaks through the skin, will not stay in line, or is badly displaced. The bone is put back in place and held with pins, wires, screws or a plate. Pins are often removed in clinic once the bone has healed.

Read more about paediatric orthopaedics in Dubai and fracture care.

After the cast comes off

• Stiffness in the wrist or elbow is normal and usually goes in 2 to 3 weeks without physiotherapy.
• The bone is weaker for a while. Avoid climbing frames and monkey bars for 3 to 4 weeks after a forearm cast.
• Keep every follow-up appointment, especially after a growth plate fracture.

When to see a doctor

See a doctor the same day if your child has pain after a fall that does not settle, will not use an arm, has a limp, or has swelling and tenderness near a joint. Some growth plate fractures do not show clearly on X-ray, so the examination matters.

Call 998 for an ambulance, or go straight to an emergency department, if the limb looks bent or out of shape, bone is visible through the skin, the hand or foot is numb, pale or cold, or the pain is severe.