Paediatric Orthopaedic Clinic

The Specialist Orthopedic Clinic  at Gertrude’s Children’s Hospital provides the comprehensive pediatric orthopedic care. We specialize in orthopedic problems that affect children, including fractures, injuries, movement disorders, and bone and joint abnormalities. Our team consists of experienced orthopedic surgeons, doctors, nurses with special training in orthopedic conditions, rehabilitation experts, physical therapists, and numerous other collaborating support staff. We work to give considerate and compassionate care to children of all ages. We offer a wide range of services with a keen focus on quality, value, and education.  

 

What is a fracture? 

A “fracture” a broken bone. A bone can break in different ways: crosswise, lengthwise, in several places, or into many pieces. It might bend, crack, break all the way through, or shatter. If the broken bone sticks out through the skin it is called an “open” fracture. If If it doesn’t break through the skin it is called a “closed” fracture. 

 

How are children’s bones different from adult ones? 

Children have softer, more flexible bones. When force is applied to them during injury they are more likely to bend more rather than break. Children’s broken bones heal faster than in adults. 

 

What are the types of fractures that are commonly suffered by children? 

Buckle fractures occur when the bone compresses and crumples on one side of the bone.In buckle fractures there may be pain with pressure or movement, swelling, and/or bruising of the skin over the affected area. Falling on an outstretched hand is the commonest cause of this type of fracture. The lower part of the forearm is most frequently involved area.Treatment will typically involve immobilizing the limb for a short duration (3 to 4 weeks) using a cast or a splint. The most appropriate treatment option will be arrived at after considering the specific fracture, the comfort of the child and the comfort of the parent. Discuss the treatment options with your doctor.[Text Wrapping Break] 

Greenstick fractures occur when the bone is pulled too far on one side of the bone.The bone bends beyond it’s elastic limit but the force is not enough to cause a clear break. It is called “greenstick” because it behaves like a young green branch of a tree which more likely bends than breaks. It commonly results from injuries which involve bending or twisting of a limb like when a child tries to catch himself when falling. A fall or impact to the limb could also cause  a greenstick fracture. It can be very painful. Babies and toddlers may cry inconsolably. There maybe swelling, pain, and reduced use of affected limb due to tenderness during movement. Treatment of greenstick fractures depends on how severe it is. It may involve immobilising the limb using a cast or a splint. This keeps the bones in place during healing and to prevent further breakage. If the bone bends significantly and looks deformed the orthopedic doctor may straighten it manually. Pain medication or anesthesia may be given during this procedure.Greenstick fractures typically take 4 to 8 weeks to heal. 

 

Complete fractures  occur when the disruption goes completely through the bone.Depending on the direction the fracture line takes one may talk about spiral, transverse, or oblique fracture. The fracture ends of the bone may or may not be aligned. 

 

Growth Plate Fractures. Growth plates are areas of a long bone where new bone growth takes place. It is the weakest part of the long bone. A fracture that develops near or at the end of a long bone can damage the growth plate.Growth plate injuries usually happen at the bones of the legs,forearms, ankle, wrist, foot and hip bone. Most are caused by sudden impact such as a fall or a hard hit to the limb. Doctors will diagnose  a growth plate fracture in your child by asking questions about the injury, examining the child and taking X-rays. For more serious injuries MRI or CT scan may be ordered. Most growth plate injuries get better without lasting problems; usually within 3 weeks. However, serious damage or failure to treat growth plate injuries may lead to a limb becoming increasingly angulated, a limb becoming shorter than the other, or poor alignment of joints. Treatment depends on the type of injury, the severity of the injury and the age of the child. The least serious injuries may be treated by  immobilizing the injured limb in a cast or splint. A growth plate fracture may need to be realigned surgically to improve the chances of recovering and growing again. Follow-up visits may be required until the child’s bones stop growing. 

 

What are the most commonly fractured sites in children? 

The most common fracture in children is a break of the part of the radius bone which is close to the wrist. It is known as a distal radial fracture. It is usually caused by a fall on the outstretched hand. Symptoms include bruising, pain, and swelling. The wrist area may look deformed. More often it is a buckle fracture. 

 

The supracondylar fracture is the most common type of fracture around the elbow. It is a fracture at the lower part of the bone of the arm (humerus) just above the elbow. Typical symptoms include elbow pain, tenderness, swelling, and decreased range of elbow movements. It may result from a fall onto an outstretched hand or a direct impact to the elbow region. With appropriate orthopedic treatment it heals well without problem. Sometimes serious complications can arise if the fracture is not anticipated,diagnosed and treated promptly. Bleeding into and swelling around the elbow can cause pressure that can reduce the flow of blood. Injury to nerves can occur. Stiffness can occur long after healing. 

 

Fractures frequently occur on the shafts of the bones of the forearm (the area between the wrist and the elbow). Most occur following a fall on an outstretched hand and are commonly associated with falls from playground equipment and/or backyard trampolines. Many of them are greenstick fractures. Others may be complete or even with multiple fragments of bone. A direct blow to the middle of the forearm may cause an isolated fracture to one of the bones of the forearm. Symptoms include  swelling, pain, and deformity at the middle forearm with reduced range of motion of the hand, wrist, and elbow. Treatment depends on the type of fracture and severity of the injuries. Most children with mid shaft fracture of the forearm will need the bones to be put back in place and the limb immobilised using a cast or splint. More serious injuries may require surgical intervention. Discuss the treatment options with your orthopedic doctor. 

 

Other commonly injured sites sites include the shin bone, the long bone of the thigh, the long bone of the arm, the collar bone, the ankle, the foot, and the hand. 

 

When should I call my child’s doctor? 

See your child’s doctor when your child develops pain, swelling, bruising, or deformity in a limb; if the child is not able to move or put weight on that part of the body. 

Visit you doctor immediately if there bleeding or abnormal sensation in a limb. 

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