Over the past weekend, our local BYC 6th grade lacrosse team participated in the Bishop Shanahan Middle School All Star Lacrosse Tournament in Downingtown, Pa. The starting time was 1pm and the finishing time was 8pm. The 6th grade girls participated in five twenty-five minute lacrosse games. Three of the girls from BYC additionally, participated in an All Star game that was 40 minutes in length. This was a long day of lacrosse and potential for injury is high with this much activity. But with competition comes the competitive spirit and would a player admit the depth of their injury or play on? Would a coach or parent be able to recognize a serious injury? These questions are sometimes difficult to diagnose with children who sometimes do not show obvious signs, i.e. swelling at the site.
When children fall, instinct tells them to put out their hands to brace themselves. This leads to a high rate of hand, wrist and elbow fractures. Fractures in the forearm, area between the wrist and elbow account for 40 to 50 percent of all fractures in childhood and elbow fractures 10 percent, Lindsey Marcellin , MD, MPH. Children’s bones break differently from adults. This is one of the reason it may be hard for a parent to diagnose right away. Children’s bones are less brittle and may not break all the way through. “Kids can get what we call a ‘buckle fracture,’ where the bone bends but doesn’t break all the way,”says Barbara Frankowski, MD, MPH, a professor of pediatrics at the University of Vermont College of Medicine.
Some times it is hard to tell these days when children seem to continue to play even with a broken bone. As opposed to just bruises broken bones are usually ‘point tender’, says Dr. Frankowski. Point tender means that the injury will hurt in a specific location, usually where the break in the bone is located. Here are some signs:
- Swelling at the site
- unable or unwilling to move the injury body part
- Even if able to move but still complains of pain, notify your doctor
Types of Fractures from Healthy Children
- Greenstick fracture. When the bone bends like green wood and breaks only on one side.
- Torus fracture. When the bone is buckled, twisted, and weakened but not completely broken.
- Bend fracture. When the bone is bent but not broken. (this is relatively common in young children)
- Complete fracture. When the bone breaks all the way through.
Classification of fractures
- Non-displaced. When the broken ends are still in proper position.
- Displaced. When the ends are separated or out of alignment.
- Open or compound. When the bone sticks through the skin. If the skin is intact, the fracture is ‘closed’.
Broken bones that involve the growth plate
This is very serious. When the breaks involved damage to the growth plates at the end of the bones, future growth of that bone can be effected. The bone may be stunted or may grow at an incorrect angle. Even more scary, is that the damage may not be visible for a year or more and by then may be hard to correct. Fractures that are known to involve growth plates may need surgery to risk future growth plate problems.
What to do prior to the doctors visit: R.I.C.E. (Kid’s Health Center)
- Rest and tell the child not to use the injured limb.
- Ice: 20 minutes on and 20 minutes off.
- Compression: ace bandage the area to keep it still and to decrease swelling.
- Elevate: Keep limb raised above the heart to prevent swelling.
First an x-ray will be taken to ensure the bone is broken and what type of break occurred. Depending on the injury the child will receive, cast, splint, or surgically place pin, to hold the bone in the correct position. Children heal quickly so whatever brace was chosen should stay on a few weeks or months, depending on the extent of the injury. Young bones need not be aligned perfectly. As long as they are in about the right place they will remodel as they grow. Rehabilitation may be necessary before returning to normal activities.
Note: If while in the cast, the child has increased pain, numbness, or pale or blue fingers or toes, call your doctor immediately. This is a sign that the extremity is swollen and needs more room within the cast. If not relieved, the swelling may press on nerves, muscles, and blood vessels causing permanent damage.
Trust your instincts. If something isn’t right go get it checked out. Even if it proves not to be broken some times peace of mind is enough.