Children get injured all the time. They scrape their knees falling off bikes. They bruise their foreheads in a jungle gym mishap. Sometimes, they even break a bone, often in their arm or leg (the wrist and elbow are the most common fractures of the arm in children, typically from trying to catch themselves). It can be difficult to know how to tell if a child’s arm is broken, sprained or something else
“The easiest way to identify a fracture is if there’s a deformity: If your child falls on their arm and it appears bent or abnormally shaped compared to their other arm, it’s most likely broken or fractured,” said Dr. R. Gunnar Tysklind, a pediatric orthopedic surgeon at Riley Children’s Health. “It gets a bit trickier when you have a small fracture without any obvious deformity. The biggest clue then is if there’s a large amount of swelling or excessive tenderness when you press on that area.”
The typical signs that your child has a broken bone
- Deformity. If your child is hurt and the affected area looks deformed in a way it didn’t before, it could be because of a broken bone.
- Pain. It is often very difficult to tell a break from a sprain based upon pain.
- Swelling and bruising. Swelling and bruising around the affected area can indicate a broken bone underneath.
- Loss of mobility. When something breaks, it can become more difficult to use that limb, and the child often won’t place weight through the extremity.
Your child might also have a sprain, which is an injury to the ligaments or soft tissue around the bone or joint, or a strain, which is the stretching or tearing of a muscle or the tendon that connects the muscle to bone.
How do you know when to go to the ER?
“I usually tell families if there’s no gross deformity—the leg or arm looks like a leg or arm—you don’t need to bring them in for an emergency visit. Even if it ends up being a very small fracture or a bad sprain, it’s okay to wait a day or two to see if the pain improves with some ice and anti-inflammatory medications like ibuprofen,” Dr. Tysklind said. “If your child is still having significant pain or doesn’t want to use the arm or walk on the leg, then it’s time to bring them in.”
If your child is experiencing severe pain or has an obvious deformity or bone that breaks through the skin, it’s time to go to the emergency room. However, if the pain is less severe and the symptoms unclear, Dr. Tysklind recommends urgent care facilities and walk-in orthopedic clinics like the Riley Pediatric Orthopedics & Sports Medicine in Carmel.
“The walk-in clinic at IU Health North Hospital is staffed by either an orthopedic surgeon or physician assistant who only treats pediatric patients with fractures or acute injuries. In this setting, you’ll have x-rays, answers and follow-up care scheduled, all in one place,” Dr. Tysklind said.
What to expect from bone fracture treatment
When you arrive for treatment of a suspected broken bone, you can expect your child to undergo a thorough examination and possibly an x-ray. Less commonly, if the doctor needs to look at the soft tissue around the bone, they may order advanced imaging like a CT, or MRI scan. X-rays not only confirm a fractured bone, but also inform how to treat the injury with casting or surgery.
“Sometimes we can put patients in a cast for a short period of time to heal,” Dr. Tysklind said. “Other patients need to have the fracture re-adjusted (manipulated) to get it realigned and then casted. And some patients need surgery to repair the break. It really depends on how bad the fracture is and where it’s located.”
If the bone is not broken, and instead a sprain is suspected, your child might get a splint or removable brace until the area heals. These usually last for two to five weeks before your child can return to normal activities. Pain relief for child with broken arm, strain or sprain typically includes ibuprofen, acetaminophen, ice and immobilization for a short period of time.
“If you child ultimately needs surgery, it depends on where the fracture is and the patient’s age. With younger patients, we can sometimes reset the bone without making any incisions. We put in pins to hold things together, which can be removed later in clinic,” Dr. Tysklind said. “If the bone is displaced, or certain areas aren’t amenable to pins, it may require a different kind of surgery. These types of fractures need surgery to reassemble the bone with various types of metal implants.”
Complications and growth plates
The fact that children are still growing is both helpful and challenging when repairing broken bones. While there are different options to approach treatment for children than adults, kids can develop unique complications related to their bone growth. The typical signs a broken bone is not healing are continued pain and swelling. As the broken bone heals, the pain typically improves. If the pain persists, call your child’s doctor.
Some parents are concerned about how a broken bone may affect their child’s growth plate, the cartilage disc along the end of a long bone that allows it to grow. If not treated properly, fractures to growth plates can affect the bone’s growth. As an orthopedic surgeon, Dr. Tysklind and his colleagues at the walk-in clinic are familiar with these types of fractures and how to approach them to help preserve normal growth.
“It’s very common for these fractures to break through or involve a growth plate, which can cause the growth plate to shut down and stop growing. This can result in deformity or limbs growing to different lengths,” Dr. Tysklind said. “We monitor these patients with x-rays to ensure their treatment is progressing appropriately. Treatment with either surgery or casting is aimed at minimizing the damage to the growth plate and helping prevent growth plate-related complications.”
After your child’s fracture or sprain is treated, be sure to keep your follow-up appointments to ensure their recovery continues smoothly and they can get back to their normal, active life.
This orthopedic clinic offers walk-in office hours Monday through Friday, 9 am - 3:30 pm. This unique offering provides patients same-day access with a highly skilled pediatric orthopedic surgeon or advanced practice provider for fractures, suspected fractures and acute injuries. This service does not require patients or physicians to call ahead of time to receive pediatric care.
Last updated: 10/5/2023
Last review by: Robert G. Tysklind, MD