Children are naturally active and resilient, but they’re not just “small adults” when it comes to
bones and joints. Growing bodies have unique patterns of injuries and orthopedic conditions. As
a parent or caregiver, you might face anything from a toddler’s broken arm after a playground
fall, to a grade-schooler’s limping from a twisted ankle, or concerns about your child’s walking
pattern and leg alignment. In this comprehensive guide, we’ll walk you through common
pediatric orthopedic conditions – including fractures, sports injuries, and developmental
deformities – in a warm, educational tone. We’ll explain how children’s bones differ from
adults’, what treatment options exist (often far more kids’ fractures can heal with simple casts
than you’d expect!), and when it’s important to seek specialty care from a pediatric orthopedist.
We’ll also cover growth-related issues like in-toeing, flat feet, and leg length differences, helping
you understand what’s normal and what might need intervention. Throughout, we’ll optimize for
search terms you might be using, such as pediatric trauma, broken bones in kids, pediatric
orthopedic injuries, gait problems, and growth-related issues – so you can find the answers you
need. Let’s dive in, with clear headings and an easy-to-read format, to demystify your child’s
orthopedic health.
Why Kids’ Bones Are Different: Understanding Pediatric Orthopedics
Children’s bones are continually growing and changing. This growth provides some advantages
and poses some challenges:
- Growth Plates: Kids have growth plates (physes) at the ends of long bones – these are
areas of developing cartilage where new bone is made, allowing the bones to lengthen as
the child grows. Growth plates are weaker than solid bone, so injuries in children often
involve the growth plate. A twist or fall that might sprain an adult’s ankle could cause a
growth plate fracture in a child’s ankle. The presence of growth plates also means kids
have the remarkable ability to remodel mild angulations or deformities as they grow. For
example, a child’s broken bone might heal slightly crooked but then straighten out over
time as the bone lengthens. This is a big difference from adults – adult bones won’t
correct themselves once healed, but kids’ often do to an extent. - Periosteum: Children’s bones have a thick, strong periosteum (the outer layer of bone)
which is more active in healing. This means kids’ fractures heal faster than adults. It also
means kids often get incomplete fractures – instead of a clean break snapping the bone in
two, the bone may crack on one side and bend on the other, like a green twig. These are
called greenstick fractures or buckle (torus) fractures. They’re common in children’s
wrists and forearms because of that flexibility. - Ligaments vs Bones: In kids, ligaments (which connect bones at joints) are relatively
stronger compared to bone than in adults. So a force that might cause a sprain (ligament
stretch/tear) in an adult often causes a fracture in a child. It’s not always possible to tell a
sprain from a fracture without an X-ray, so when in doubt, we evaluate for fracture. - Healing Potential: Because of rich blood supply and growth factors, children’s injuries
generally heal quickly and well. Broken bones can heal in a matter of weeks (4-6 weeks
for many fractures), and even surgeries like fixing a fracture with pins or plates usually show
rapid recovery. However, the downside is that if a growth plate is significantly
damaged, it can lead to growth disturbances (like one leg ending up shorter if the growth
plate closes too early). That’s why any injury involving a growth plate needs careful
follow-up for up to 1-2 years.
Understanding these differences underpins why pediatric orthopedic care is a specialty – treating
children’s injuries and conditions requires knowledge of growth and development. As one
pediatric ortho mantra goes: children are not just mini adults; they are still “under construction.”
This is actually good news – it means they can often bounce back from injuries more easily, and
sometimes less invasive treatments are needed because their bodies will take care of the rest.
Common Fractures in Children and Their Treatment
Fractures (broken bones) are among the most common injuries in kids. In fact, about 50% of
boys and 40% of girls will have at least one fracture before age 16. Once kids start walking and
especially when they become adventurous climbers, the risk of falls and injuries goes up.
Most Common Fracture Sites:
- The wrist (distal radius) is the champion of childhood fractures. When kids fall
onto an outstretched hand (FOOSH injury), it’s often the wrist that breaks. These
can be buckle fractures or complete fractures. It’s so common that in an active
practice we cast countless wrists every year. - The elbow is another frequent site, especially a type of fracture called
supracondylar fracture (just above the elbow) in younger kids who fall off
monkey bars or furniture. - The forearm (both radius and ulna) – kids often break both bones in the forearm.
- The clavicle (collarbone) – a very common break from falls or sports, and even in
newborns sometimes from birth trauma. You’ll notice a bump on the collarbone as
it heals (that’s a normal healing callus). - The ankle – can be growth plate fractures around the distal tibia/fibula, often
from sports or tripping. - For toddlers, a unique one is the “toddler’s fracture” – a small spiral break in the
tibia (shin bone) from a simple twist while stumbling; child might just limp
without a big trauma. - The femur (thigh bone) in younger kids, though strong, can break in high-energy
falls or car accidents, or occasionally in a less severe fall if something else is
going on (like bone cyst or osteogenesis imperfecta). - Fingers are also commonly broken (like getting caught in a door).
According to one source, aside from the wrist, other common fractures in kids include forearm,
clavicle, and lower leg – which aligns with practical experience.
Signs of a Fracture vs a Sprain:
It can be tricky to tell, and even doctors rely on X-rays to confirm. Some clues: If there’s obvious
deformity (arm or leg looks “bent” where it shouldn’t be, or a bony bump sticking out), it’s a
fracture for sure. Swelling and bruising occur in both sprains and fractures. Sometimes kids with
a small fracture will still use the limb a bit, and you might not know – a limp or using the other hand
more may be the only sign. Rule of thumb: if your child refuses to use the limb, or if pain
and swelling are significant, they should be evaluated and likely get an X-ray. It’s better to check
– an untreated fracture can heal wrong.
Initial Steps if You Suspect a Fracture:
- Stabilize the limb: You can make a quick splint with a magazine or a pillow wrapped
around the arm or leg to keep it from moving too much. - Ice and Elevation: This helps with swelling and pain.
- Pain relief: Children’s acetaminophen or ibuprofen per recommended dose is fine to give.
- Seek medical care: If deformity is present or pain is high, go to an emergency room. If it’s
mild and you’re not sure, an urgent care or your pediatrician might do an initial check, but
often they will refer you for X-ray anyway. If the limb looks very deformed or circulation is
affected (fingertips/toes cold or pale) – that’s an emergency (call 911 or go to ER right away).
For many pediatric fractures without deformity, it might be reasonable to wait until the next
day to see an orthopedic specialist.
Treatment of Common Fractures:
- Casting & Splinting: The majority of children’s fractures can be treated non-surgically.
A cast (typically made of fiberglass or plaster) immobilizes the bone to allow healing.
Children usually need casts for shorter durations than adults – often 3-6 weeks is enough
for many fractures. Some minor fractures don’t even require a full cast; a removable
brace or splint can suffice. For instance, buckle fractures of the wrist often heal
beautifully with just 3-4 weeks in a Velcro wrist brace – no hard cast needed. This is great
because you can remove it for bathing and it’s more convenient. Pediatric orthopedists
have been at the forefront of using removable splints for minor fractures to make life
easier. - Reduction: If a fracture is displaced (the bone pieces aren’t aligned well), a reduction
may be needed – that’s when a doctor manipulates the bones back into alignment. In kids,
this is often done in the ER or clinic with sedation or anesthesia (they won’t feel it) and
then casting. Children’s bones are a bit forgiving in alignment because of remodeling, but
there are limits. - Surgery: Some fractures do need surgery – if the bone is badly displaced or if it involves
the joint or growth plate in a way that must be precisely aligned. Common surgeries
include:-
- Pinning (closed reduction and percutaneous pinning): For a badly broken
elbow (supracondylar fracture), we align the bone and insert a couple of small
pins through the skin to hold it in place. - Internal fixation: Using screws or plates for certain fractures, like a displaced
ankle growth plate fracture or a femur fracture in an older child. - Flexible nailing: For femur fractures in kids, flexible titanium nails inserted into
the bone can stabilize it without the need for a big surgical incision. - External fixation: Rarely, for complex fractures, a frame outside the body holds
pins in the bone (commonly for some open fractures or those with wounds).
- Pinning (closed reduction and percutaneous pinning): For a badly broken
-
Healing and Aftercare:
Kids usually manage well with casts – initial days they might be uncomfortable, but they adapt
quickly. We advise:
- Keep the cast dry (unless it’s a waterproof type, which some places offer for fiberglass
casts with special lining – great for swimming and bathing!). - Keep it clean – kids like to shove things inside casts (itching can be an issue), but
discourage that to avoid sores or stuck objects. - Watch for swelling: keep limb elevated especially first 48 hours and encourage gentle
finger/toe movement to prevent stiffness. - Pain is usually much better after immobilization; a little pain medicine is used early on,
but often kids need only minimal doses after the first day or two. - Follow-up visits: typically, an X-ray a week or two later to ensure alignment is holding.
Beyond Broken Bones: Common Injuries and Ailments in Active Kids
Not all orthopedic issues are fractures. Kids who are active in sports or play might encounter:
- Sprains and Strains: Though younger kids are more likely to fracture than sprain, older
children and teens (especially in sports) do get sprained ankles, knee injuries, etc. - Growth Plate Injuries (Physeal Injuries): Overuse can cause irritation of growth plates,
leading to conditions like Sever’s disease or Osgood-Schlatter disease. - Dislocations: A common one in toddlers is nursemaid’s elbow, which is quickly fixable
with a simple maneuver. - Sports injuries: In teens, we see adult-like injuries: ACL tears, patellar dislocations, or
stress fractures in runners. - Concussions: Though not an orthopedic injury, concussions often accompany sports
injuries.
When to See a Pediatric Orthopedic Specialist:
- If a fracture is suspected or confirmed.
- If an injury isn’t improving in a few days or has persistent swelling/pain.
- If your child has a limp or joint swelling without a clear injury.
- For any growth plate fracture, it’s wise to have a pediatric orthopedist involved.
Growth and Development: What’s Normal, What’s Not
- Intoeing (“Pigeon-toed” walking): A common and usually benign condition.
- Bowlegs and Knock-Knees: Normal in toddlers and preschoolers, but we monitor them.
- Flat Feet: Common in toddlers; usually benign but can benefit from supportive footwear.
- Toe Walking: Can persist past age 3 and may require evaluation.
- Limping: If persistent or painful, requires evaluation for conditions like Legg-Calve-
Perthes or SCFE. - Back Pain: Shouldn’t be a concern in younger kids; it warrants evaluation if it’s
persistent.
The Importance of Pediatric Orthopedic Care
Throughout all these scenarios, one theme emerges: children do best when treated by those who
understand kids’ unique needs. A pediatric orthopedic specialist will:
- Treat the whole child with growth in mind.
- Use child-friendly techniques and equipment.
- Offer family-centered communication to explain treatments.
- Provide expert care and coordinate with other specialists when needed.
Growing Strong with Expert Care
Children’s bones have a tremendous capacity to heal and adapt, and with the guidance of
pediatric orthopedic experts, most orthopedic problems in kids can be managed effectively,
ensuring your child grows up with healthy, strong bones and joints. Our warm, understanding
approach ensures that the care is not just top-notch in expertise, but also considerate of a child’s
fears and a parent’s anxieties.
📅 Schedule a consultation today to learn more about treatment options.