Fracture is the term used for a broken bone. Fractures are a common childhood injury because young children have bones that are growing and not yet fully developed, and this makes them more fragile than adult bones.
Fractures can occur in any bone of the body but the most common fracture injuries in children are wrists, arms and elbows, which usually occur after a fall.
Most fractures heal well and cause no long-term complications.
Signs and symptoms of a fracture
Older children will usually be able to tell you where they are sore and can explain what happened to cause the injury. This can make it easier to identify if a fracture has occurred. It can be more difficult to identify a fracture in infants or toddlers. They may cry and not use the
affected area, but there may be no obvious injury.
If you think your child has a fracture, they may have the following symptoms:
- pain or tenderness at the injury site
- swelling or redness around the injury
- deformity (unusual shape) of the injured area
- not wanting to move or use the injured area.
On rare occasions the force of an injury can cause the skin over a fracture to split – this is called a compound fracture. There may only be a small break in the skin (the bone may not be sticking out of the wound). If this has occurred, it is important to see your GP or go to your local hospital
emergency department.
Sometimes children will not have any of the above symptoms and a fracture may not be noticeable even if an injury has occurred.
First aid treatment for fractures
First aid treatment for fractures aims to provide comfort to your child, helps to reduce swelling, and provides your child with pain relief until the fracture is treated.
Apply the following first aid for a suspected fracture, then seek medical help:
- give them some pain relief (e.g. paracetamol or ibuprofen)
- reduce movement of the injured area if possible, by applying a splint or sling
- apply an ice pack to the injury
- elevate the limb.
When to see a doctor
If you think your child has a fracture, or you are unsure, you should follow the first aid steps above, then take them to see a GP or go to your local hospital emergency department.
Call an ambulance or take your child to your local emergency department immediately if:
- your child has injured their arm and they are in severe pain
- a limb looks deformed
- a limb looks blueish or is an unusual colour
- your child has a limb injury and there is a large cut where the injury has occurred
- a bone is sticking out, or if there is a large amount of bleeding that cannot be stopped.
To diagnose a fracture, a GP or doctor will need to examine your child (which may or may not include an X-ray) to determine the type of injury and where it is located.
Some GP clinics can treat patients with fractures as they have appropriate facilities and can perform X-rays and follow-up care. In other cases, your GP may refer your child to a hospital to be treated by a doctor or nurse practitioner in the emergency department.
Treatment
If your child has a fracture, they will need to restrict movement of the injury site to allow the bone time to heal.
Some fractures may require a splint or backslab (partial cast), held in place with bandages. A splint or partial cast helps to support the injured area, allowing it to rest and heal while also providing your child pain relief. A splint or partial cast generally does not have to be worn for as
long as a full cast.
Casts are required for three weeks to three months depending on the type and location of the injury – your doctor will estimate how long it will be required.
If the injury has caused the bones to move out of place, a doctor, nurse practitioner or, in some cases, a surgeon will need to move the bones back into the correct position (known as a reduction). These procedures are usually done under sedation or anaesthesia in the emergency department or
operating theatre. Fractures that require a reduction will need a full plaster cast (one that wraps around the limb) to allow the injury to heal. Full plaster casts stay on your child for up to three months, depending on the injury.
Care at home
Encourage your child to rest for the first few days following a fracture. Your child should also avoid physical activities – if a child falls onto their plaster cast or damages it, the fractured bone can move out of alignment and it may not heal in the correct position.
When caring for a fracture at home, it is important to:
- monitor your child’s pain
- keep the injured area elevated to reduce swelling
- monitor your child’s skin and follow any instructions given to you by your doctor to care for the cast.
Casts and splints should remain dry at all times. If they become wet, the splint can become damaged and the skin underneath can become irritated.
Your child should never sleep with their sling on, so remember to remove your child’s sling before bedtime. Try and keep the injured area elevated for at least the first three nights (or longer if directed by your doctor) by using an extra pillow or folded blanket.
For tips on how to relieve itching and for more information about caring for a cast at home, see our fact sheet
Plaster cast care.
Follow-up
After seeing your GP or doctor, your child may have a follow-up appointment one to two weeks after the injury. It is important to attend this appointment as your child’s fracture will be checked to ensure the bones are healing well. If your child requires any further follow-up
appointments or tests, your doctor will let you know.
For most minor fractures, your local GP can manage your child’s ongoing follow up. However, some fractures will require a follow up X-ray and review by an orthopaedic surgeon who will tell you how long your child needs to have their cast on.
At any time, take your child back to your GP or local hospital if:
- the cast is cracked, soft, too loose, too tight, or has rough edges that hurt
- you are worried that an object has been pushed inside the cast
- there is a bad smell or ooze coming from the cast
- your child is in increasing pain
- you are concerned for any other reason.
After the cast is removed
Once the cast has been removed, your child’s skin may be dry and itchy. Bathe the skin with warm soapy water, and apply a plain, non-perfumed moisturiser.
After a fracture, children normally regain strength by gradually participating in gentle activity and play. Physiotherapy is usually not needed.
Your doctor will give you specific advice about when and how your child can return to sport (usually about four to six weeks after the cast is removed). If your child had surgery, full contact sports should be avoided for two to three months, but you should discuss this with your child’s doctor.
Key points to remember
- Fractures are a common childhood injury because children’s bones are not yet fully developed.
- Most fractures heal well and cause no long-term complications.
- Fractures are usually treated by using a splint or a cast (full or partial) to restrict movement until the bone heals.
- Looking after the cast is important to ensure your child’s bone heals correctly and to prevent damage to their skin.
- Depending on the type of injury, the cast will need to stay on for up to three months and your doctor will let you know if you require any follow up appointments.
For more information
Common questions our doctors are asked
My child’s bones needed to be straightened. Will this affect
them long term?
Most children who required a reduction of their injury heal
well with no further complications. Your doctor or nurse practitioner will let
you know if your child requires a follow up appointment. It is important to
attend this appointment so that your child can be assessed to ensure the injury
is healing appropriately and as expected.
The fracture affected something called the growth plate.
Does that mean that my child’s arm or leg will stop growing?
This sometimes depends on the age of your child
or the type of injury. Most of the time injuries to the growth plate do not
interrupt the growth of the limb if they are treated early. The injury will be
monitored as part of your follow up to ensure the injury is healing well.
Developed by The Royal Children's Hospital Emergency department. We acknowledge the input of RCH consumers and carers.
Reviewed November 2018.
This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.
Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit
www.rchfoundation.org.au.