Fractures

A fracture is a broken bone. When a child experiences a fracture, it’s different than when an adult breaks the same bone.

Distal Radius Fractures

The radius is located in the forearm. The forearm consists of two bones, the radius and the ulna. The radius is the larger bone. A distal radius fracture occurs when there is a break at the end of the radius bone closer to the hand rather than the elbow. A distal radius fracture is the most common area to break a bone in the arm. This injury usually occurs with a fall on an outstretched hand. At times, the other bone in the forearm breaks. This would be called an ulna fracture. Sometimes both bones break at the same time.

Symptoms

When there is a break in the bone of the wrist, it usually causes immediate pain. There can be swelling and bruising. If the bone is angulated, the wrist will lock bent or deformed. Ice, Elevation, and a spirit may be used to help with the discomfort initially. If there is associated numbness or tingling of the hand or fingers, or if the fingers are not pink and your child cannot move his/her fingers, immediate evaluation treatment is needed.

Treatment

Most distal radius fractures can be treated non-surgically with some type of immobilization such as a cast. If the fracture is angulated or out of place, it may need to be realigned to the proper position. This is called a “closed reduction”. It is a good idea to elevate the injured arm above the heart for the first 24-48 hours after the injury to help decrease swelling and pain. A child is typically immobilized in a cast for 4 to 7 weeks depending on the severity of the break. Your child may need periodic follow up visits with your physician to evaluate how the case is fitting and the alignment of the bones, which is evaluated by x-rays. IT IS VERY IMPORTANT TO KEEP THE SCHEDULED APPOINTMENTS. IF APPOINTMENTS ARE MISSED, THE FRACTURE MAY MOVE AND HEAL INCORRECTLY.

Pain may be managed with over-the-counter medications, such as Tylenol/acetaminophen or Motrin/Advil/Ibuprofen given as instructed on the package. If there is associated numbness or tingling of the hand or fingers, or if the fingers are not pink and your child cannot move his/her fingers, immediate evaluation treatment is needed.

What happens after the fracture heals?

In general, after the bone has healed, kids return to their normal activities without any consequences of the fracture. Most children do not require any physical therapy. Restriction of contact sports and physical activity is usually for 4 weeks after the cast is removed depending on the severity of the fracture.
Generally, your child may begin to progress in activities as tolerated thereafter. Stiffness around the wrist joint after the cast is removed is common. Typically, children’s motion and strength is returned to normal 1 to 3 months after the cast is removed. In order to help with wrist strength and movement, you may fill the sink with warm water and have the child move their wrist in circular motion, such as with washing dishes and then squeeze the water out of the sponge to regain hand strength

Elbow Fractures

Throughout childhood, children often fall. Whether your child Is an athlete or just playing around, injuries are a part of growing up. In most cases, falls are harmless, but there are occasions when a fall results in a serious injury. Most elbow fractures occur when a child falls on an outstretched arm with a lot of force from the fall. This Impact can cause a fracture or break near the elbow. It Is important to have these injuries evaluated by a medical professional soon after injury to prevent complications.

What bones make up the elbow?

There are three bones that create the elbow joint. Three bones, along with the ligaments, tendons and muscles allow the elbow to move like a hinge, bending and straightening. The big bone is the humerus, which makes up the upper part of the arm. The radius and the ulna are the two bones of the forearm (or lower arm). The radius bone runs along the side of the thumb and the ulna bone runs along the side of the small finger.

Types of Elbow Fractures

There are several types of elbow fractures. The most common include:

• Supracondylar Fractures – This is a break in the humerus bone, just above the elbow. This fracture is the most common elbow fracture in children under eight years of age, but also the most serious since it can cause problems with circulation and nerve function.
• Condyle Fractures – These ate breaks of the bony prominences on each side of the elbow. The most common is a break on the outside or Lateral Condyle.
• Olecranon Fractures – These breaks occur on the bony tip of the elbow. With little muscle or soft tissue covering the bone, it is a common fracture with direct fall onto the elbow.
• Radial Neck Fractures – These are a break of one of the forearm bones near the elbow joint. This fracture is common in children who fall on an outstretched hand. The force of the fall is transmitted from the hand, up the arm to the elbow joint.
• Fracture Dislocation – A dislocation at the top of the radius bone with a fracture of the ulna bone is called a Monteggia fracture.

Treatment for Elbow Fractures

There are several different treatment options depending on the fracture that occurred and how severe it is. If the fracture is not displaced, a cast will be applied for a period of 4 to 6 weeks with periodic x-rays. It is important to keep the follow-up appointments to ensure proper healing. If the fracture is displaced, a “reduction” will be required or the bones will need to be pushed back into place. Most children regain their motion 1 to 2 months after the cast is removed. Children are usually restricted from sports for about 4 weeks after cast removal to prevent reinjury. In most cases, physical therapy is not required.

If successful reduction is not achieved, or if the fracture moves out of place after reduction, surgery may be required. Surgery includes placing the bones back into place in the operating room with hardware, such as pins, screws, and/or wires.

Low Risk Ankle Fractures

What is a low risk ankle fracture?

Low risk ankle fractures are those ankle fractures that have little to no chance of displacement, do
not require surgery and only require brief immobilization. Based on your X-rays, your provider
determined you had an ankle fracture considered “Low Risk.”

How can I help prevent ankle fractures?

Wear proper, well-fitting shoes when you exercise. Stretch gently and adequately before and after athletic or recreational activities. Avoid sharp turns and quick changes in direction and movement. Consider taping the ankle or wearing a brace for strenuous sports, especially if you have had a previous injury.

Low risk ankle fracture treatment:

Initial treatment includes the following easy to remember Acronym, LUSKIN:

Immobilization
Immobilization is usually recommended for a period of 4 weeks. If provided a CAM boot, wear the CAM boot at all times except for hygiene and two-times-daily exercises. NSAIDs such as ibuprofen can help with both pain and swelling. Ibuprofen can be taken every 6 to 8 hours for the first 7 to 10 days after injury. For kids, dosage is based on weight, so check the package instructions. For teens and adults, 400 mg, or two regular strength tablets, of ibuprofen is appropriate.

Post-Injury Rehabilitation Completing ankle exercises to improve your ankle strength and range of
motion and help you return to your normal activity or sports.

• Week 3 after injury and when the previous exercises are pain free, start exercises #5 and 6
• Starting Day #1 after your diagnosis, start exercise # 1 and 2
• Week 1-2 after injury and when you can tolerate weight on your foot, start exercises #3 and 4

Towel Stretch
Sit on a hard surface with your injured leg stretched out in front of you. Loop a towel around the ball of your foot and pull the towel toward your body while keeping your knee straight. Hold this position for thirty seconds and repeat three times.

Ankle Alphabets
Sit upright with your foot hanging off the edge of a table. Pretend you are writing each of the letters of the alphabet in capital letters with your foot. This moves your ankle in all directions. The movement should come from your ankle, not from your hip or knee. Do this three times.

Standing Calf Stretch
Facing a wall, place your hands against the wall at about eye level. Keep the uninjured leg forward and your injured leg back about 12 to 18 inches. Keep your injured leg straight with your heel on the floor and your toes pointed toward the wall. Bend the knee of the forward leg into a slight lunge and lean into the wall until you feel a stretch in your calf muscle. Hold for 30 to 60 seconds and repeat three times.

Standing Soleus Stretch
Facing a wall, place your hands against the wall at about eye level. Keep the uninjured leg forward and your injured leg back about 4 to 6 inches. Keep both heels on the ground and gently bend your knees until you feel a stretch in your calf muscle. Hold this position for 30 to 60 seconds and repeat three times.

Heel Raises
While standing on the floor or on a small step, balance yourself on both feet and hold onto a wall for balance. Rise up on your toes, hold for five seconds, and then lower yourself back down. Repeat 10 times and complete three sets of 10. Once you are comfortable with this, try on one leg and complete three sets of 10.

Single Leg Balance
Stand without any support and attempt to balance on your injured leg. Begin with your eyes open, then try to perform the exercise with your eyes closed or on a pillow with your non-standing foot in front of you, to the side of you, and behind you for 30 seconds each. Repeat three times.

When can I return to my sport or activity?

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If
you return too soon, you may worsen your injury, which could lead to permanent damage.
Everyone recovers at a different rate. Returning to your sport or activity will be determined by how
soon your ankle recovers, not by how many days or weeks it has been since your injury has
occurred. In general, the longer you have symptoms before you start treatment, the longer it will
take to get better.
You may safely return to your sport or activity when, starting from the top of the list and
progressing to the end, each of the following is true:

• You have full range of motion in the injured ankle, compared to the uninjured ankle
• You have full strength of the injured ankle compared to the uninjured ankle and are able to
  complete the above exercises without pain
• You can jog straight ahead without pain or limping
• You can sprint straight ahead without pain or limping
• You can jump on both legs without pain, and you can jump on the injured leg without pain
  Return to your sport at about 50% effort, and increase by about 10% each week. If you begin with
  pain, you may need to rest for a few days before returning to activities.