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Children's Health

Toddler fracture question

02/02/2009

Question:

my son is a very active 3 and 7 onths. after spending the morning running, jumping and saving the world, he started limping. the limping quickly progressed to pain when touching the leg. i took him to the er where x-rays showed a small line on the tibia. they put him in a cast and told me it was a toddlers fracture". yjere was never a moment when he fell or yelled in pain. is this common? i always thought bone breaks were after a trauma. there is no bruising or swelling either. and is it common for biones to just break in young healthy kids?

Answer:

Children differ from adults in many ways. Compared to adults, children's bones are more porous than are adult bones, which are well calcified and hard. Children's bones are more prone to fractures because of their porosity and because their ligaments are stronger than their bones. It is the reverse in adults. Adults suffer sprains while children suffer fractures.

Children also have different types of fractures than do adults because of these bony differences. Children experience greenstick fractures, which are a partial crack through the bone rather than a full separation of the bone segments. They also have buckle fractures where the more porous bone is basically compressed downwards in one area but the bone is not broken through. They also have bend fractures where a long bone is clearly bent but not cracked through.

Unlike adults, children also have growth plates that actively lengthen bones throughout life. Adults have no active growth plates in their bones. Fractures through these growth plates are called Salter-Harris fractures. These are particularly difficult fractures because a child may lose all or part of their bone's growth plate causing uneven growth of the bone as well as a difference in bone length from one side of the body to the other. this results in obvious problems in movement and appearance that are difficult to correct. 

Happily your son saw a good pediatric doctor who recognized his fracture and casted him. Even when the bone is not separated, a fracture is still very painful and feels a lot better when it is immobilized in a cast. As a young child, he will also heal quickly.

While it is possible that your son could have an underlying problem with his bones, that is unlikely. If he has more fractures after little impact or malformed teeth, then it is worth discussing a possible problem with his doctor. Otherwise, he is just a normal, active little boy with a normal child's more fracture-prone bones.

I hope he heals quickly and uneventfully!

McMillan et al. (Eds.) (2006). Oski's Pediatrics: Principles and Practice (4th Edition). Philadelphia: Lippincort, Williams, and Wilkins.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University