Sticks and stones and broken bones: The long-term effects of childhood injuries
Whether falling off a bike or getting injured on the soccer field, many children experience one or more broken bones before reaching adulthood.
"The most common fractures involve the wrist, forearm and area above the elbow," says
Candice Pfeiffer Holden, MD, a Virtua/duPont Children's Health Program pediatric orthopaedic surgeon. "These usually occur when children throw their hands out to stop a fall."
Growth plates
While the majority of childhood breaks heal quickly, problems may arise when breaks involve growth plates. A growth plate is the area at either end of a bone where cartilage cells multiply rapidly and form new bone as a child grows. Because the growth plate is the last part of the bone to harden, it is often weaker than the surrounding ligaments and therefore more vulnerable to fracture and harder to heal.
"When a growth plate is displaced or the blood supply is cut off due to a damaged blood vessel, there is a risk that the cells will stop growing," explains Dr. Holden. "This can prevent bone growth and lead to deformities such as shortened or crooked limbs." Additional concerns arise when there is an open fracture — a bone that breaks through the skin. This injury is susceptible to infection that destroys the growth plate cells. And, any break involving a joint like the knee or ankle can lead to an increased risk for arthritis.
That's why growth plate injuries require immediate attention to reduce the risk of infection and ensure proper bone alignment. Treatment depends upon the location and severity of the fracture and whether any nearby nerves or blood vessels are affected.
"A displaced fracture, in which the pieces on either side of the break do not line up, often is treated with closed-reduction surgery; this does not involve opening the skin," says Dr. Holden. "The child is sedated, and the doctor sets the bone in position before casting it."
The most serious cases
In more serious cases such as those resulting from motor vehicle crashes or high-impact sports like football, open surgery may be needed and may involve inserting a metal pin to keep the bones in place as they heal. For injuries involving the knees or ankles, Dr. Holden uses a thin tube called an arthroscope to examine and repair fractures. This minimally invasive technique results in less scarring and quicker recovery for the child.
With proper treatment and long-term monitoring to ensure continued bone growth, the National Institute of Arthritis and Musculoskeletal and Skin Diseases estimates that 85% of growth plate injuries heal without any lasting effect.
An amazing capacity to heal
"Children have an amazing capacity to heal," concludes Dr. Holden. "In all but the most serious injuries, the child can resume normal activities within weeks."
For a tip sheet on how to prevent childhood injuries, call
1-888-Virtua-3.
Meet the physician
Candice Pfeiffer Holden, MD, graduated from the University of Southern California (USC) School of Medicine in Los Angeles. She completed a residency in orthopaedic surgery at Los Angeles California/USC Medical Center and a fellowship in pediatric orthopaedic surgery at the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware. Dr. Holden has presented on a range of sports medicine topics and has published articles in the
Journal of the American Academy of Orthopaedic Surgeons.