Introduction

A bone fracture, or broken bone, is a crack or break in a bone. Babies and children are at higher risk of fractures because their bones are still growing.

Fractures can range from minor to severe and can happen to any bone.

Types of fractures can include:

  • simple – where the bone breaks but does not go through the skin
  • compound – where the bone breaks through the skin
  • hairline – a small type of break that happens from repeated stress, like running
  • greenstick – where one side of the bone breaks, causing the other side to bend.

Bone fractures can happen due to things like:

  • accidental falls or injuries
  • assault
  • repeated stress on the bones from activities like running and jumping
  • breaks or cuts in the bone during surgery
  • weakness in the bone caused by illnesses or treatments, like cancer. 

Signs and symptoms

If your child has a bone fracture, they will generally feel some pain.  

The level of pain and type of symptoms your child has will depend on: 

  • the bone that was fractured
  • how it was fractured
  • the type of fracture.

Common symptoms can include:

  • tenderness
  • swelling
  • pain when moving
  • breaks in the skin
  • bleeding.

Take your child to your local doctor or nearest emergency department if they have these symptoms after any type of accident or injury. 

Diagnosis

Fractures are usually diagnosed using scans that take a detailed picture of the bones. 

Depending on which bone was fractured, your child’s doctor may order scans to get a clear picture of the bone. 

These include:

They will also physically check your child’s symptoms to see if there are any other injuries.

Treatment

Treatment of a bone fracture will depend on:

  • what type of fracture it is
  • which bone was fractured
  • whether your child has any other injuries.

Casts and braces

Most bone fractures can be treated by holding the bone in place while it heals over time.

Fractures can be held in place with:

  • full or partial plaster casts
  • bandages or slings
  • a splint or brace.

Your child may need to wear a cast, bandage, or splint for six weeks or more. This will depend on the bone that is fractured and how severe the fracture is.

Surgery

Some fractures may need surgery before they can start to heal properly.

Surgery for bone fractures can involve:

  • moving the bone back into place
  • cleaning out the wound
  • holding the bone in place with hardware like metal screws or plates.

Your child’s doctor will let you know what type of treatment will be used for the fracture and how to look after it while your child recovers.

Management

How a bone fracture heals

Fractured bones usually heal well in children because they are still growing. 

The bone will start to repair itself a few weeks after fracturing, but it can take longer to regain its regular strength. 

Bones will generally heal in 4 stages.

  1. Inflammation (0-1 weeks)

When a bone fractures, the immune system sends signals that trigger pain, swelling, and redness. This signals your body to stop using the affected body part while it heals.

  1. Callus (2-6 weeks) 

New fibres and tissue gradually replace blood clots in the bone, forming a callus. A callus is new bone tissue that holds the bone together while it repairs itself. 

The callus can be felt as a hard lump and seen on an X-ray by a doctor.
 

  1. Healing (6+ weeks) 

By week 6, the callus will be strong enough for gentle movement. As the fracture heals, the callus will slowly be replaced with normal bone tissue. 

This should not be painful, and your child‘s new bone should gradually get back to full strength over six weeks to three months.

  1. Modelling 

Bent bones in children can straighten as they heal through a process called remodelling. Remodelling is possible until the bones stop growing in their teenage years.

Looking after a plaster cast

You will be given specific instructions for looking after your child’s plaster cast, bandage, or splint at home.

Parents and carers will need to help their child to:

  • elevate or lift the fractured bone where possible, propping it up on a pillow when sitting or lying down
  • avoid resting the plaster cast on any hard surfaces to prevent pressure sores
  • use any slings, crutches or wheelchairs as directed by the doctor or physiotherapist
  • wrap the cast with a plastic bag and tape during showers and baths, keeping it out of the water 
  • let small amounts of moisture on the cast air dry naturally 
  • keep the cast away from direct heat, like hot water bottles, hair dryers and electric blankets
  • leave the cast alone, avoiding moisture, heat, and cuts to the plaster.

If the cast becomes loose, cracked, or soft or does not keep the bone in place properly, take your child to the nearest emergency department.

Skin care and plaster casts

A plaster cast covers the skin and stops your child from being able to scratch any itches. It is very important that your child does not try to push anything down into the cast like:

  • knitting needles
  • chopsticks
  • pens
  • coat hangers.

Inserting objects inside a plaster cast can lead to skin damage and infection. Objects left or stuck inside can cause painful pressure sores and ulcers that can be life-threatening. 

Take your child to the nearest emergency department if you think they have inserted an object into the cast or there is:

  • yellow or green liquid staining the plaster
  • a foul or rotten smell coming from the plaster.

Returning to activity

Children must rest and avoid activities like sports, rough play, or lifting for six weeks while their fracture heals. The doctor will let you know when it's safe for them to return to normal activities. 

Your child may need to see a physiotherapist or exercise physiologist to regain full strength with gentle exercises. Moving other body parts gently during rest periods can help with any stiffness.

When to seek help

See your local doctor as soon as possible If your child has:

  • severe pain, swelling or numbness around the fracture that does not go away
  • swelling of the fingers or toes.
  • blueness or whiteness of the fingers or toes, compared to other body parts
  • pins and needles, tingling or burning
  • numbness or loss of feeling
  • lost the ability to move their fingers and toes
  • pain that cannot be managed by pain relief medication.

Disclaimer

This factsheet is provided for general information only. It does not constitute health advice and should not be used to diagnose or treat any health condition.

Please consult with your doctor or other health professional to make sure this information is right for you and/or your child.

The Sydney Children’s Hospitals Network does not accept responsibility for inaccuracies or omissions, the interpretation of the information, or for success or appropriateness of any treatment described in the factsheet.

© Sydney Children’s Hospitals Network 2024