Broken Bones and Fractures

The growth plate is the area of growing tissue near the end of the long bones in children. Each long bone has at least two growth plates, one at each end. The growth plate determines the future length and shape of the adult bone. When growth is complete, the growth plates close and are replaced by solid bone.

Growth plates are prone to injury because they are weak compared to the surrounding stable bone, ligaments, and tendons.

Because the growth plate is the weakest area of the growing skeleton, a serious injury is more likely to damage a growth plate than the ligaments that stabilize the joint.

If the growth plate is shifted, shattered, or crushed, a bony bridge can form, which can result in an abnormality, such as stunted growth.

A reduction is done when a broken bone is put back into proper alignment. There are two types of reduction:

• Closed reduction. Closed reduction may be performed when you have a single break that has not broken the skin and when plates, pins, or screws are not needed to hold the bone in place. During a closed reduction procedure, your health care provider will push the broken bone back into position and place the broken are in a case or splint to keep secure.

• Open reduction. Surgery to set a broken bone is called an open reduction of a fracture. During surgery, the skin is cut open and the bones are put back in place. The bones will be held in place with special screws or by attaching metal plates to the bone. Pins that go through the bone, or rods that go inside the length of the bone, are used to keep the bone in place.

Splints and casts support a fractured bone and help to reduce pain and swelling.

Casts are made of Plaster of Paris or fiberglass. A fiberglass cast is water resistant, while a plaster cast will dissolve if it gets wet. Fiberglass or plaster materials form the hard outside layer; however both fiberglass and plaster casts use padding, usually cotton, as a protective layer next to the skin. If this cotton padding becomes wet, significant problems may develop, such as the development of rashes or infections.

A new Gortex cast padding has been developed, which is completely waterproof and allows a patient to completely immerse the cast in water without a plastic bag. It should be noted, however, that this padding is much more expensive.

Splints are made in a variety of shapes and sizes, and are much easier and faster to use. They have Velcro straps which make the splints easy to adjust, and easier to put on and take off. Splints offer less support and protection and are commonly used in soft-tissue injuries.

An open fracture is a broken bone that breaks through the skin. When a broken bone breaks through the skin, immediate treatment and an operation is often required to clean the area of the fracture. Due to the risks of infection, additional problems associated with the healing of the fracture can develop.

Open fractures are typically caused by high-energy injuries such as car crashes, falls, or sports injuries.

When someone suffers a broken bone, it is important for the bones to be properly aligned. One method of realignment is using a splint or cast. The length of time a person must wear a splint or cast depends on the severity of the injury.

When there is an open fracture, a person may require surgical repair of the bones. If the fracture is severe, rods, plates and screws may be required to repair the broken bones.

Once the fracture is secured, an accident victim may need to use crutches, a walker or wear a sling during the healing process.

Physical therapy is also necessary for some patients, depending on their age and physical condition. Pain medication and muscle relaxers are also prescribed to assist through the healing process.

When referring to a bone, the term "fracture" and "break" are the same. It is a misconception that a "break" is worse than a "fracture".

A fracture can occur as a result of a sudden impact, like in a car crash or fall; or because of continued pressure applied to the bone. There are various types of fractures, which include:

• Simple fracture - when the bone is broken into two pieces and separates.
• Hairline fracture - when the bone cracks but doesn't separate. They appear like "hairs" in an x ray.
• Comminuted Fracture - when the bone is broken into more than two pieces. Often, two major pieces and a smaller piece.
• Avulsion Fracture - when a portion of the bone is pulled away from the bone by a tendon.
• Greenstick fractures - when the bone develops tiny fissures without actually breaking into separate pieces.
• Compound fractures - when the bone breaks and punctures the skin. These are particularly complicated to treat and are dangerous because they create the possibility of infection.