Recommended articles

Categories

Fractures in children: symptoms, treatment and prevention

Fractures in children: symptoms, treatment and prevention

Fractures in children are one of the most common pediatric orthopedic emergencies. Due to their high level of physical activity, energetic play, and the relative fragility of growing bones, children are at a much higher risk of injury compared to adults. It is estimated that up to 50% of boys and 40% of girls will suffer at least one fracture by the age of 16. At Elytis, we understand the complexity of these injuries and offer pediatric orthopedic services tailored to each child’s needs.

What are fractures in children?

A fracture is a break in the continuity of a bone, usually caused by trauma. In children, fractures have specific characteristics due to the nature of their bones during growth. Their bones are more flexible and contain more collagen, which means that sometimes the fracture is incomplete or takes atypical forms that are difficult to detect during a simple examination.

How do children's bones differ from those of adults?

It is important to understand the differences between adult bones and children’s bones in order to better understand why bone fractures in children behave differently and require specific management.

  • Increased elasticity – a child's bone can bend or crack without breaking completely.
  • Thicker and stronger periosteum—this protective layer promotes rapid healing.
  • Growth plates (physis) – vulnerable areas where trauma can affect normal bone development.
  • Remodeling capacity – a child’s bone can correct itself and align better over time compared to an adult’s bone.

What types of fractures are common in childhood?

Given the characteristics of children’s bones, the fractures they suffer also have certain distinctive features. Here are the most common types of pediatric fractures:

  • A “green wood” fracture—the bone cracks on one side, but the periosteum on the other side remains intact, like a twig that breaks only partially.
  • Torsional (spiral) fracture – occurs mainly during play or sports, when the limb rotates suddenly.
  • Complete fracture – the bone breaks into two distinct fragments, sometimes with displacement.
  • Epiphyseal fractures—which involve the growth plate—are the most significant in terms of the risk of complications, as they can affect the bone’s future development.

Why are epiphyseal fractures so important?

Epiphyseal fractures are of particular concern to doctors because, if not treated properly, these injuries can lead to a halt or slowdown in bone growth, deformities, or differences in limb length. They require special attention and, sometimes, surgery to prevent permanent problems.

What are the common causes of fractures in children?

Fractures occur when a bone is subjected to a force greater than it can withstand. In children, they often occur during intense physical activity or as a result of everyday accidents. Factors that increase the risk of fracture include both external circumstances (trauma) and internal factors (bone weakness).

Common External Causes

  • Accidents at home—falls from furniture, stairs, or out of bed; contact with hard objects.
  • Sports and play—soccer, basketball, cycling, jumping, and other activities involving the risk of impact or falling.
  • Traffic accidents—crossing the street, riding a bicycle or scooter, even with incomplete protective gear.
  • Overuse injuries—stress microfractures in sports involving intense repetitive movements (gymnastics, dance).

Internal factors that increase the risk of fracture

  • Vitamin D deficiency —affects calcium absorption and bone health.
  • Pediatric osteoporosis or osteogenesis imperfecta—bones that are fragile or prone to multiple fractures.
  • Malnutrition or a diet low in calcium—affects bone density and strength.
  • Metabolic or endocrine problems—hormonal imbalances that affect normal bone development.

How do external factors interact with internal ones?

A child with weaker bones or nutritional deficiencies is much more vulnerable to fractures, even from minor injuries. Therefore, prevention involves both ensuring a safe environment and supervising physical activities, as well as maintaining bone health through diet and supplements, if necessary.

How Can You Recognize Fractures in Children? (Symptoms and Signs)

Fractures can be easily noticeable or more subtle, depending on the type and severity of the injury. The main signs include:

  • Intense, immediate pain—occurs at the site of the injury and worsens with movement or pressure.
  • Swelling and redness—the area became inflamed quickly after the accident.
  • Limb deformity—the bone may appear to be out of its normal position, or the affected segment may be curved.
  • Limited movement—the child cannot move the affected arm or leg normally, and walking or bearing weight may be impossible.
  • A “pop” sound during an injury—sometimes parents or the child hear a distinct sound at the moment of the accident.

What are the signs of a medical emergency?

  • Open fracture—the bone protrudes through the skin, posing a risk of serious infection.
  • Heavy bleeding—requires immediate medical attention.
  • Loss of sensation or numbness—may indicate damage to nerves or blood vessels.
  • Abnormal skin color—bluish or pale—is a sign of impaired circulation.

More subtle or hard-to-detect symptoms:

  • Moderate pain following minor falls, which persists for several days.
  • The inability to fully use an arm or leg, even if the deformity is not visible.
  • Avoidance of movement or frequent crying for no apparent reason.

Why is it important to see a doctor even if your symptoms seem minor?

In children, bones are more flexible and can sustain microfractures or “greenstick” fractures that are not immediately apparent. Early diagnosis through physical examination and X-rays prevents complications and ensures proper healing.

What types of fractures are most common in children?

Fractures in children can affect various bone segments, and identifying the type of fracture is essential for determining the correct treatment. The most common types are:

Forearm Fractures

  • Location: radius and ulna.
  • Common causes: falling onto an outstretched hand while playing or participating in sports.
  • Characteristics: pain, swelling, slight deformity; sometimes visible “greenwood” fractures.
  • Typical treatment: immobilization with a cast or brace; in cases involving displacement, reduction and fixation.

Supracondylar Fractures (Elbow)

  • Location: humerus, just above the elbow.
  • Common causes: falls from a height or direct impact to the elbow.
  • Symptoms: severe pain, swelling, difficulty moving the elbow, visible deformity.
  • Treatment: orthopedic or surgical reduction, followed by immobilization and physical therapy.

Fractures of the tibia and femur

  • Location: thigh (femur) and lower leg (tibia).
  • Causes: falls, traffic accidents, high-impact sports.
  • Characteristics: severe pain, inability to walk, visible deformity; in cases involving the femur, surgery is often necessary.
  • Treatment: cast, internal or external fixation, physical therapy.

Clavicle Fractures

  • Location: the clavicle.
  • Common causes: falls onto the shoulder or an outstretched arm.
  • Symptoms: shoulder pain, swelling, limited mobility.
  • Treatment: a special bandage or temporary immobilization; surgery is rarely necessary.

Epiphyseal (growth plate) fractures

  • Location: the ends of the long bones (knee, elbow, wrist).
  • Causes: moderate or severe trauma; high-impact or twisting sports.
  • Characteristics: localized pain, swelling, tenderness on palpation; sometimes without obvious deformity.
  • Treatment: immobilization; sometimes surgery to protect the cartilage and ensure normal bone growth.

Epiphyseal fractures require close monitoring, as damage to the growth plate can lead to limb length discrepancies or long-term deformities.

How are fractures diagnosed in children?

The diagnosis of pediatric fractures combines a careful clinical examination with imaging studies. In children, some fractures may be subtle or hidden, so the evaluation must be prompt and thorough to prevent complications.

Clinical Examination

  • History of the injury: The doctor asks about the mechanism of the accident, when it occurred, and the immediate symptoms.
  • Visual inspection: Check for deformities, swelling, bruises, or bleeding.
  • Palpation of the affected segment: the exact location of the pain, crepitus, or tenderness.
  • Assessment of mobility: The examiner checks whether the limb can be moved and whether there is any loss of function or significant pain during movement.
  • Vascular and neurological examination: the pulse, sensation, and reflexes are checked to detect any associated lesions.

X-ray (RX)

An X-ray is the simplest method used to confirm the presence of a fracture, as well as its type and degree of displacement.

The main advantages of X-rays are that they are quick, available even in small medical centers, and inexpensive.

Unfortunately, X-rays also have some limitations, the most significant of which is that “greenwood” fractures or epiphyseal fractures can sometimes be difficult to visualize.

Further investigations

Assessment of the Type of Fracture

Based on the clinical examination and X-rays, the doctor can determine:

  • Simple or compound fracture (the bone pierces the skin)
  • Displacement of bone fragments
  • Involvement of the growth plate (crucial for prognosis)

Why is an accurate and prompt diagnosis important?

Early diagnosis allows for the selection of the appropriate treatment—conservative or surgical—thereby preventing deformities, nonunion, and loss of function.

How are fractures treated in children?

The treatment of pediatric fractures depends on the type, severity, and location of the fracture, as well as the child’s age. The main goal is to ensure proper bone healing and preserve the function of the affected limb, with minimal risk of complications.

Conservative (non-surgical) treatment

There are several conservative treatment options that a pediatric orthopedic specialist can use to immobilize the bone ends and promote healing:

  • Immobilization with a cast or splint: This is used for fractures without displacement or with minor displacement. The duration depends on the affected bone and the child’s age (usually 3–6 weeks for mild fractures).
  • Mobilization brace: It allows for a limited range of motion but protects the fractured area.
  • Radiographic monitoring: Periodic X-rays are used to check for proper alignment and bone callus formation.

The most important advantages of conservative treatment are:

  • Avoid surgery and the associated risks.
  • Rapid healing thanks to a child's bone remodeling capacity.

Surgical treatment

Surgical treatment is indicated in situations such as:

  • Fractures with significant displacement or unstable fractures.
  • Epiphyseal fractures involving the growth plate.
  • Complex fractures of the femur, tibia, or elbow.

Frequently used procedures for immobilizing bone ends include:

  • Fastened with metal pins or rods.
  • Screws or plates for internal stabilization.
  • External fixation in severe cases.

Recovery is achieved through postoperative immobilization, followed by physical therapy to restore mobility and muscle strength.

Post-Fracture Recovery

Medical rehabilitation is extremely important for restoring muscle strength and promoting a full recovery. It may include:

  • Physical Therapy: exercises tailored to restore strength, mobility, and coordination.
  • Nutrition: a diet rich in calcium and vitamin D to strengthen bones.
  • Long-term monitoring: especially for epiphyseal fractures, to prevent leg length discrepancies or bone deformities.

Important Notes

  • Children recover faster than adults because of rapid bone remodeling.
  • Following your doctor's instructions and avoiding overexertion of the limb are essential for a full recovery.
  • Close monitoring after the cast is removed helps prevent recurrence or further injuries.

What complications can arise from a fracture in a child?

Although most pediatric fractures heal well, some can lead to complications if they are not diagnosed or treated properly. It is important for parents to be aware of these risks so they can take action in a timely manner.

Vicious Healing (Vicious Callus)

Malunion means that the bone heals in an incorrect position, with an unnatural angle or curvature. 

Common causes of malunion include uncorrected bone fragment displacement, unstable fractures, or failure to immobilize the injury.

Improper healing results in impaired limb function, posture, or gait. 

Correcting a deformed callus sometimes requires surgery or intensive physical therapy.

Impaired bone growth (epiphyseal fractures)

Impaired bone growth, which is more common in epiphyseal fractures, means that trauma to the growth plate can stop or slow bone growth.

The causes of this complication are torsional fractures or displaced fractures at the epiphysis.

Without proper management, differences in limb length or bone deformities may occur.

Treatment involves long-term monitoring and, if necessary, corrective surgery.

Joint stiffness

Loss of normal mobility in the affected joint may result from prolonged immobilization, severe trauma, or a lack of rehabilitation exercises.

Treatment consists of physical therapy, mobilization exercises, and, rarely, surgery.

Infections

Infections are complications that occur mainly in open fractures or after surgery. Characteristic signs include redness, swelling, discharge, or fever.

Treatment involves administering antibiotics, surgical debridement if necessary, and close monitoring.

Other complications

There are other possible, though rarer, complications, such as:

  • Internal bleeding or subcutaneous hematoma.
  • Damage to nerves or blood vessels in severe cases.
  • Psychological trauma: fear of movement or physical activity following an accident.

Continuous monitoring after a fracture and adherence to the treatment plan prescribed by the doctor significantly reduce the risk of complications.

How can fractures in children be prevented?

Fracture prevention combines supervision of physical activities, protective equipment, proper nutrition, and education for both children and parents.

Monitoring of Activities and the Environment

  • Make sure play areas are safe: no sharp objects, dangerous edges, or slippery surfaces.
  • Supervise children during sports activities and games that involve a risk of falling.
  • Encourage games that are appropriate for the child's age and level of coordination.

Appropriate protective equipment

  • Helmet, knee pads, and elbow pads for bicycles, scooters, or roller skates.
  • The right shoes that provide stability and cushioning when running or jumping.
  • Belts and protective gear for contact sports (soccer, handball, karate).

Nutrition and Bone Health

  • A balanced diet rich in calcium (milk, cheese, yogurt, green vegetables).
  • Vitamin D for calcium absorption and bone strength (moderate sun exposure and supplements if necessary).
  • Preventing nutritional deficiencies that can weaken bones and increase the risk of fractures.

Child and Parent Education

  • Teach your child to be mindful of their surroundings and their own physical limits.
  • Explain the safety rules for sports and play.
  • Encourage your child to report any pain or discomfort immediately after an injury.

Other Preventive Measures

  • Regular pediatric checkups to assess bone development.
  • Posture correction and balance exercises to reduce the risk of falls.
  • Avoid letting young children engage in risky activities without supervision.

A combination of safety measures, proper nutrition, and education significantly reduces the risk of fractures and serious injuries.

When should you take your child to the hospital immediately?

Quickly recognizing the signs of a serious fracture or complications can make the difference between a full recovery and long-term problems. Parents should be on the lookout for the following situations:

Intense and persistent pain

  • If the pain does not improve even after applying ice, resting, or taking the recommended pain relievers, you should see a doctor for an imaging evaluation.
  • Even seemingly minor fractures can involve subtle displacements that require orthopedic treatment.

Visible deformation of the limb

  • A bone displaced from its normal position, abnormal curvature, or rotation of the affected segment are clear signs of a severe fracture.
  • These require immediate action to ensure proper realignment.

Inability to move or support one's own weight

  • The child cannot lift his or her arm or put weight on the affected leg.
  • The inability to move indicates either a severe fracture or joint damage.

Open fracture or profuse bleeding

  • A bone protruding through the skin or a wound with heavy bleeding is an absolute emergency.
  • The risk of infection and tissue damage is high and requires prompt intervention.

Neurological or vascular signs

  • Numbness, loss of sensation, paleness, or a bluish discoloration of the affected limb.
  • These signs may indicate nerve or blood circulation problems and should be evaluated immediately.

Even if there is no visible deformity, if a fracture is suspected (pain, swelling, limited movement), it is safer to see a doctor for an evaluation and an X-ray.

The Benefits of Pediatric Care at Elytis Hospital

At Elytis Hospital, the team of specialists in pediatric orthopedics ensures an accurate diagnosis, personalized treatment, and a full recovery, taking into account the specific needs of children. Children are not just small adults: their bones heal differently, and treatments must be tailored to their age.

The team of pediatric orthopedic specialists

  • Doctors with experience in fractures specific to children and adolescents.
  • Ability to quickly assess the type and severity of the fracture, reducing the risk of complications.

Modern, child-centered diagnosis

  • Digital radiology with low radiation doses, specifically for pediatric patients.
  • Access to advanced imaging (CT, MRI) for complex fractures or epiphysial fractures.

Personalized Treatment

  • Immobilization with a cast or braces tailored to the child's size and age.
  • Minimally invasive surgical procedures, if necessary.
  • Careful post-treatment monitoring to ensure proper alignment and optimal healing.

Multidisciplinary Supervised Recovery

  • Pediatric Physical Therapy: Exercises Tailored to Restore Mobility and Strength.
  • Nutritional Support: Recommendations for Bone Strengthening and Recurrence Prevention.
  • Psychological support: assistance for children who develop anxiety or a fear of physical activities following an accident.

Safety and Comfort for Your Child

  • A child-friendly environment that reduces the stress and anxiety associated with medical visits.
  • Staff specialized in managing fear, pain, and working with young children.

Choosing Elytis Hospital for your child’s fractures means access to specialized treatment, appropriate equipment, close monitoring, and a full recovery, increasing the chances of a complication-free healing process.

Frequently Asked Questions About Fractures in Children

How long does it take for a child's fracture to heal?

The duration depends on the type of fracture and the child's age:

  • Simple fractures of the arm or leg: 3–6 weeks.
  • Complex fractures or epiphysial fractures: 6–12 weeks, sometimes longer. Children recover more quickly than adults due to their capacity for bone remodeling. Physical therapy can accelerate functional recovery.

Will the bone heal normally after a fracture?

Most children make a full recovery, especially if the fracture is treated properly.

  • Epiphyseal fractures require long-term monitoring to prevent differences in leg length or deformities.
  • Follow-up X-rays and regular visits to the orthopedist ensure normal bone growth.

When can the child resume sports activities?

  • Physical activities can be resumed gradually after the cast is removed and recovery is complete.
  • The doctor will determine the exact timing based on the type of fracture, bone stability, and the progress of your recovery.
  • Physical therapy helps restore mobility, strength, and balance, reducing the risk of recurrence.

What should I do if I suspect a fracture, but the child can still move the limb?

  • Even if the limb is moving, the bone may be cracked or partially fractured (“green bone fracture”).
  • It is recommended that you see a doctor for an evaluation and an X-ray to avoid future complications.

Is there a risk of recurrence after a fracture?

  • The risk is particularly high if the fractured area is overused too soon or if physical activity is not adapted to the level of recovery.
  • Following the doctor's instructions and supervising the child's activities significantly reduce the risk of a relapse.

What preventive measures can I take to avoid future fractures?

  • Close supervision during play and sports.
  • Use of protective gear (helmet, knee pads, elbow pads).
  • A diet rich in calcium and vitamin D.
  • Balance and coordination exercises to reduce the risk of falls.

Fractures in children are common, but with early diagnosis and proper treatment, most heal completely without complications. Knowing the symptoms, warning signs, and preventive measures is essential for parents to ensure their child’s safety and health.

At Elytis Hospital, our team of pediatric orthopedic surgeons combines medical expertise with modern technology and a child-friendly approach. We provide personalized treatment, close monitoring, and comprehensive rehabilitation so that every child can quickly return to their normal activities and safely develop their physical potential.

Schedule an appointment now at Elytis Hospital and ensure your child receives the specialized care they need for a quick and complete recovery!

Latest medical review:

28.05.2025, Dr. Narcis Narcis Ilioaia Cozmescu-Petraru - Specialist Physician

References: