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Is that a Fracture? After-School Fun Can Lead to Emergency Room Visit

By Sam Smith, MD, Surgeon in Chief, Arkansas Children's Hospital

It's true that emergency rooms across the nation consider summer to be their peak injury season. When kids are out of school, there are more opportunities for the kind of unruly fun that leads to falls and crashes.

But now that the school year has been going strong for several weeks, our Emergency team at Arkansas Children's Hospital expects to see a spike in injuries that lead to bone fractures among kids. Why? Because after being cooped up in classrooms all day, children are looking for every opportunity to push harder and do more after the school bell rings.

This time of year, kids are tired from a full day of school, but they also have plenty of energy to burn off. And if they're playing with neighbors or in an after-hours recreation program, they may also be showing off just a little bit. With other kids around, they tend to run a little faster, jump a little higher, try to show they can climb a little higher on the tree or monkey bars. Basic kid stuff, right?

But the fatigue that a full day of instruction can create means children are also a little less aware of their surroundings and may show poorer judgment than when they're well rested. So the bike ride that gave them no trouble on a nice morning in late June may not be as smooth in the evening after eight hours of classes.

In those post-school and pre-dark hours, the Emergency Department at ACH tends to see quite a few adventurous kids with fractures. The most common breaks we see are in the forearm. Obviously, kids try to brace themselves when they're falling, jumping or landing, and the bone can't support that pressure. We also see some fractures in the legs and feet because of bicycle crashes.

How can you, as a parent, know if your child's fall or crash has resulted in a fracture? It's not easy to figure out, unfortunately. Just about every physician with children can tell you that they misjudged such an injury in their own son or daughter. So if you suspect it could be a fracture, it's always OK to seek the opinion of an objective medical professional who can take X-rays to make a diagnosis.

Generally, though, if the child doesn't seem to be limiting the use of the bone or joint and isn't tearful or in prolonged pain, it may be OK to treat the injury as a sprain. If your child is refusing to put weight on a foot or won't move their wrist, however, it's likely time to seek treatment.

If there is obvious deformity to the bone, you should try to splint it immediately to keep the injury from sagging and buckling. Almost any hard or straight object can serve as a temporary splint, along with belts, tied or shirts to use as a sling or to attach the splint to the area that is fractured. Almost any hard, straight object can serve as a temporary splint. Belts, ties or shirts can be used as a sling or to attach the splint to the fractured area. Make sure a splint isn't so tight that it's constricting and then immediately head to your after-hours emergency care provider.

Sometimes an injury will force the bone to protrude through the skin – what is known as a "compound fracture." These wounds are definitely frightening in appearance. If there is any opening or bleeding associated with the injury, put firm pressure on it and cover it with clean, sterile gauze. It will be important to watch for fever and infection after treatment in these cases. Also be sure not to give anything by mouth to eat or drink if you'll be seeking treatment, as this could delay necessary care.

The good news is that children usually don't need surgical intervention if they have a fracture – especially for the kind of routine breaks we see from after-school activity. Kids' bones heal quickly, so a fracture will usually repair itself after being stabilized in a cast for a few weeks. On occasion, an orthopedic surgeon may be brought in to assist if a growth plate is affected or a bone was displaced because of the injury.

At Arkansas Children's Hospital, we aim to prevent every injury we possibly can. So it's important to talk to your kids about knowing their limits and taking a break when they get tired. Though fractures are sometimes considered a rite of childhood, we'd love to see the day when the after-school hours don't fill our Emergency Department with these injuries!

Sam Smith, MD, is surgeon in chief at Arkansas Children's Hospital and a professor of Surgery at the University of Arkansas for Medical Sciences. He writes a column each week covering a variety of kids' medical concerns. If you have a topic you'd like him to consider addressing, email achconnect@archildrens.org.

Arkansas Children's Hospital
1 Children's Way
Little Rock, AR 72202-3591

Call: 501-364-1100

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