The paediatric fracture season usually starts with St Patrick's Day. With the various religious family outings and bank holidays, coupled with brighter evenings and improving weather, children are venturing outdoors and . . . crack. It's going to be a long night at the local emergency department.
A simple fall on an outstretched hand is the most common cause of fracture. In general, this is more likely to occur in a child under the age of five, more likely in boys, more likely within the home and more often during warmer months. A patient’s story frequently involves a fall from a wall or clash with a football, rugby player or hurling stick.
Bicycles and cycling result in more childhood injuries than any other childhood activity. With each spring comes the desire to participate in the most fashionable outdoor hobby and with it the ensuing wave of injuries.
Rollerskates and their variations tend to cause falls at speeds, with the wrists and knees suffering the most.
Scooters and skateboards are also becoming mainstream. Learning to ride and attempt stunts is best confined to the skatepark, as the most deadly of these accidents involve a motor vehicle.
Bouncy castles, in their playful allure, are also a frequent cause of broken limbs. Surprisingly, we see our fair share of adult injuries from these too – a combination of after-dinner drinks, an attempt to impress nieces and nephews and a lack of recent bouncing experience will give an adult an unwelcome broken arm or leg.
Equally, trampolines are a common source of broken bones, particularly when a child’s older sibling or cousin climbs on board at the same time. The addition of a surrounding safety curtain or border protection makes minimal difference to avoiding injury and neither is a substitute for adult supervision. The frame or springs at the edges are also causes of injury.
Attempting somersaults or jumping on to the trampoline from another platform increase the odds of an appearance in the emergency department, not to mention attempts to replicate whatever most-viewed viral tomfoolery YouTube can provide.
It’s worth remembering that an unwitnessed injury is occasionally the result of bullying or an assault by another child, a stranger or even a relative, so be mindful and try to find out the full story.
Once initially treated in the emergency department, paediatric fractures are usually reviewed in the local orthopaedic fracture clinic. The majority warrant little more than a clinical check, reassurance and a cast to splint the injury while it heals.
Occasionally the fracture can involve the growth plate, which adds some uncertainty to the outcome. If a child needs an operation to fix a fracture, it is always with the intention of correcting the alignment, rotation and length of the bone so that it heals in an optimal position.
The orthopaedic doctor may wish to see the child at a further appointment. They may require a repeat X-ray to check the progress of the healing. The cast may need to be removed and reapplied. You can expect a crowded clinical waiting room so bring a book, toy or an electronic gadget, and plenty of change for the parking meter.
Fortunately, children’s soft tissues and joints are quite supple. While the affected joint may be stiff on removal of the cast, it will achieve good movement within a shorter amount of time compared with a similar injury in an adult.
The journey through rehabilitation should maximise the child’s functional potential through simple exercises to stretch and strengthen the affected area. With luck, they will forget the injury ever happened.
Your child may learn the hard way from time to time, bumping into obstacles and falling on to various surfaces.
It is our common desire for young people to pursue outdoor activities and we should support community facilities to allow this. The minor injuries associated with an active lifestyle are infinitely more healthy than the conditions, including obesity, cardiovascular disease and diabetes, associated with a sedentary existence.
Dr Derek Cawley is a specialist registrar in trauma and orthopaedic surgery at Galway University Hospital and author of the free patient resource, myorthoclinic.com