Fractures in Children

Broken bones (also known as fractures) are common injuries to the hand and wrist in children. Children's bones are different than adult bones. They are softer, like fresh wood, compared to more brittle adult bones. Because children are still growing, their injuries often need different evaluation and different treatment than adults.

Figure 1

Angulated fracture through the growth plate at the base of the little finger.

Figure 2

X-ray after reduction shows normal alignment. No pinning was necessary as the fracture was stable.

Figure 3

Post-op x-ray with normal alignment stabilized with pins.

Figure 4

Displaced fracture through finger joint.

Causes

Fractures in children can happen after an injury. Fingertips can be crushed in a door, damaging the bone at the end of the finger. Younger children may be curious and put their fingers into machinery or other equipment. Active, playing children often fall while running, jumping, or climbing. Fractures may occur in sports from falls, twisting injuries, or direct blows to the hand or wrist. Commonly, a ball impacts a finger in a way that bends it too far.

Signs and Symptoms

To determine if a child has a fracture, first, an adult should provide attention to the injured child. If the finger, wrist, or forearm is crooked or there is a deep, bleeding wound, the child should be brought immediately to an emergency room. If the medical provider is concerned about a fracture, they will get x-rays. If the body part is in normal alignment and the child can move it, the injury can be monitored at home. Ice can be applied to reduce pain and swelling. The body part can be seen by a physician again later.

Not all fractures will look crooked or have major loss of mobility. If there is significant bruising or swelling, an x-ray is the only way to know for sure if a bone is broken. If there is a significant injury to the nail or skin above the nail, an x-ray may be needed to check if the bone is broken. If pain, swelling, or loss of movement persists, it is best to seek medical treatment.

A fracture that remains perfectly aligned is called a nondisplaced fracture. Sometimes this is referred to as a "hairline" fracture. A fracture that does not remain perfectly aligned due to a shift in position of the bone pieces is called a displaced fracture (Figure 1). Fractures may occur at different locations along the length of a bone, such as the middle or near the end. Some fractures enter the joint (such as the wrist joint or a finger joint).

Children's bones can break in ways that adult bones cannot. For example, children can have a buckle fracture, where part of the bone bends and part of it breaks, similar to bending a fresh branch or stick. Sometimes, the bone can bend without breaking, which is known as a greenstick fracture.

Children’s bones are unique because they have growth plates, which are bands of softer cartilage near the end of the bone that allow the bone to grow as the child grows. Since cartilage does not have calcium, growth plates can appear as a clear band on an x-ray (Figure 2). Since the growth plate is weaker than bone, it is a common site for fractures in children. Although injury to the growth plate could affect that bone’s growth, most of these fractures heal well without affecting bone growth. On average, growth plates close (turn into hard bone) at age 14 in girls and age 16 in boys. It is possible for a nondisplaced (hairline) fracture to occur through a growth plate. In this situation, the x-ray may appear normal.

Treatment

Broken bones in the forearm, wrist, and hand heal rapidly in most children. The bone can heal within three to four weeks in many cases. Most fractures in children are treated without surgery. They are usually treated with either a cast, splint, or brace, applied to the injured area for several weeks. If the broken bone is not lined up, like in a displaced (not aligned) fracture, the bone may need to be “set” or “reduced” with a manual manipulation by a physician. In some fractures, surgery may be needed to reset the fracture, and a metal plate, screws, pins, or rods can be placed in order to keep the bone in proper position while it is healing (Figure 3).

In children with a growth plate fracture, urgent diagnosis is important so that if the bone is displaced (not aligned) and needs to be realigned, it can be set before it starts to heal. After a broken bone heals, the bone gradually reshapes itself as time passes in a process known as "remodeling." Because of remodeling, a child’s fracture can heal in a bent or crooked position and gradually straighten itself over a period of weeks or months.

Certain breaks may not have to be realigned perfectly because of this ability to remodel with growth. Younger children have even greater potential for remodeling. Fractures with fragments angled in the same direction as joint motion (bending and straightening) have greater potential to remodel. On the other hand, fractures into the surface of a joint do not remodel well and may need surgery (Figure 4). Fractures that are rotated, twisted, or angled out to the side also need to be realigned more precisely as they have less potential to remodel (Figure 1). Your child's health care provider can discuss treatment options for their specific injury.

Injuries can sometimes be prevented, and sometimes not. Helping children avoid dangerous situations, like slamming their fingers in doors or putting their hand in exercise equipment, can aid in preventing fractures. Protective gear may also play a role in preventing some hand injuries in children. Protective pads including wrist guards may lessen the impact of a fall. In athletes, prevention of injuries may include use of appropriate equipment and adult supervision.

This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand. Find a hand surgeon near you.

Find a hand surgeon near you

Using this search tool means you agree to the user agreement and disclaimer.