Fractures in children, adults, and the elderly

Fractures in Children

Broken bones, or fractures, are common in childhood and often happen when kids are playing or participating in sports. Most fractures occur in the upper extremities: the wrist, the forearm, and above the elbow (or elbow fractures). Why? When kids fall, it's a natural instinct for them to throw their hands out in an attempt to stop the fall. Although many kids will have a broken bone at some point, it can be scary for them and parents alike.

Causes of Fractures in children

Fractures occur when there is more force applied to the bone than the bone can absorb. Bones are weakest when they are twisted. Breaks in bones can occur from falls, trauma, or as a result of a direct blow or kick to the body. Juvenile osteoporosis is another common cause of fractures in children.

Symptoms of a Broken Bone

Children's bones are more flexible and can absorb shock better than adult bones, so they don't break as easily, but if a bone is under too much pressure, it can still break. It might be tough for you to tell if your toddler has a broken bone, but here are some signs:

• A snapping sound
• Bruising
• Swelling
• Tenderness to touch
• Severe pain, especially in one spot
• Stiffness
• Increased pain with any movement
• Inability or unwillingness to use the limb (but if your child can move his limb or digit, that doesn't mean that it's not broken)
• A limb or joint that seems bent or out of position

Different Types of Fractures

Fracture types that are more common in kids include:

• Buckle or torus fracture: one side of the bone bends, raising a little buckle, without breaking the other side
• Greenstick fracture: a partial fracture in which one side of the bone is broken and the other side bends (this fracture resembles what would happen if you tried to break a green stick)

Mature bones are more likely to break completely. A stronger force will also result in a complete fracture of younger bones. A complete fracture may be a:

• Closed fracture: a fracture that doesn't break the skin
• Open (or compound) fracture: a fracture in which the ends of the broken bone break through the skin (these have an increased risk of infection)
• Non-displaced fracture: a fracture in which the pieces on either side of the break line up
• Displaced fracture: a fracture in which the pieces on either side of the break are out of line (which might require the doctor to realign the bones or require surgery to make sure the bones are properly aligned

Treatment for fractures in children

Although most broken bones simply need a cast to heal, other more serious fractures (such as compound fractures) might require surgery to be properly aligned and to ensure the bones stay together during the healing process. Open fractures need to be cleaned thoroughly in the sterile environment of the operating room before they're set because the bone's exposure to the air poses a risk of infection.
With breaks in larger bones or when the bone breaks into more than two pieces, the doctor may put a metal pin in the bone to help set it before placing a cast. Don't worry, though — as with any surgery, your child will be given medicine so that he or she won't feel a thing. And when the bone has healed, the doctor will remove the pin.

Fractures in the Elderly

A broken hip is a common injury, especially in elderly individuals. A "broken hip" and a "hip fracture" mean the same thing!

Causes of Hip Fractures

Hip fractures in the elderly are most often caused by a fall, usually a seemingly insignificant fall. In younger patients with stronger bones, more common causes of a broken hip include high-energy injuries such as car accidents. Hip fractures can also be caused by bone weakened from tumor or infection, a problem called a pathologic fracture.
A broken hip in the elderly can be explained primarily by weak bones and osteoporosis. Elderly patients with osteoporosis are at much higher risk of developing a hip fracture than someone without osteoporosis. Other risk factors associated with hip fracture are female sex, Caucasian race, slightly built individuals, and limited physical activity.

How much of the problem of broken hips is due to osteoporosis?

Osteoporosis is a condition that causes loss of bone mass; the composition of the bone is normal, but it is thinner than in normal individuals. With thinner, weaker bones and hip pain, patients with osteoporosis are at much greater risk for developing a hip fracture from accidents such as falls.

Treatment for Hip Fracture

Treatment for hip fracture in the elderly almost always requires surgery. In some cases, such as some stress fractures of the hip, or in patients who have severe medical problems that prevent surgical treatment, non-operative treatment may be recommended. However, most all hip fractures are treated with surgery. The type of surgery that is preferred depends on the type of fracture.

Rehabilitation

Patients are usually allowed to begin walking immediately following surgery. In some cases, if there were small fracture fragments or difficulty with alignment of the fracture, weight may be restricted. Most commonly, patients will get up with the physical therapist within a day following surgery. Time for complete healing is usually about 12 weeks, but most patients are walking well before that.