Fractured Ankle

Fractures (broken bones)

Fracture is the term used for a broken bone. Fractures are a common childhood injury because young children have bones that are growing and not yet fully developed, and this makes them more fragile than adult bones.

Fractures can occur in any bone of the body but the most common fracture injuries in children are wrists, arms and elbows, which usually occur after a fall.

Most fractures heal well and cause no long-term complications.
Signs and symptoms of a fracture

Older children will usually be able to tell you where they are sore and can explain what happened to cause the injury. This can make it easier to identify if a fracture has occurred. It can be more difficult to identify a fracture in infants or toddlers. They may cry and not use the affected area, but there may be no obvious injury.

If you think your child has a fracture, they may have the following symptoms:

pain or tenderness at the injury site
swelling or redness around the injury
deformity (unusual shape) of the injured area
not wanting to move or use the injured area.

On rare occasions the force of an injury can cause the skin over a fracture to split – this is called a compound fracture. There may only be a small break in the skin (the bone may not be sticking out of the wound). If this has occurred, it is important to see your GP or go to your local hospital emergency department.

Sometimes children will not have any of the above symptoms and a fracture may not be noticeable even if an injury has occurred.

First aid treatment for fractures

First aid treatment for fractures aims to provide comfort to your child, helps to reduce swelling, and provides your child with pain relief until the fracture is treated.

Apply the following first aid for a suspected fracture, then seek medical help:

give them some pain relief (e.g. paracetamol or ibuprofen)
reduce movement of the injured area if possible, by applying a splint or sling
apply an ice pack to the injury
elevate the limb.

When to see a doctor

If you think your child has a fracture, or you are unsure, you should follow the first aid steps above, then take them to see a GP or go to your local hospital emergency department.

Call an ambulance or take your child to your local emergency department immediately if:

your child has injured their arm and they are in severe pain
a limb looks deformed
a limb looks blueish or is an unusual colour
your child has a limb injury and there is a large cut where the injury has occurred
a bone is sticking out, or if there is a large amount of bleeding that cannot be stopped.

To diagnose a fracture, a GP or doctor will need to examine your child (which may or may not include an X-ray) to determine the type of injury and where it is located.

Some GP clinics can treat patients with fractures as they have appropriate facilities and can perform X-rays and follow-up care. In other cases, your GP may refer your child to a hospital to be treated by a doctor or nurse practitioner in the emergency department.

Treatment

If your child has a fracture, they will need to restrict movement of the injury site to allow the bone time to heal.

Some fractures may require a splint or backslab (partial cast), held in place with bandages. A splint or partial cast helps to support the injured area, allowing it to rest and heal while also providing your child pain relief. A splint or partial cast generally does not have to be worn for as long as a full cast.

Casts are required for three weeks to three months depending on the type and location of the injury – your doctor will estimate how long it will be required.

If the injury has caused the bones to move out of place, a doctor, nurse practitioner or, in some cases, a surgeon will need to move the bones back into the correct position (known as a reduction). These procedures are usually done under sedation or anaesthesia in the emergency department or operating theatre. Fractures that require a reduction will need a full plaster cast (one that wraps around the limb) to allow the injury to heal. Full plaster casts stay on your child for up to three months, depending on the injury.

Care at home

Encourage your child to rest for the first few days following a fracture. Your child should also avoid physical activities – if a child falls onto their plaster cast or damages it, the fractured bone can move out of alignment and it may not heal in the correct position.

When caring for a fracture at home, it is important to:

monitor your child’s pain
keep the injured area elevated to reduce swelling
monitor your child’s skin and follow any instructions given to you by your doctor to care for the cast.

Casts and splints should remain dry at all times. If they become wet, the splint can become damaged and the skin underneath can become irritated.

Your child should never sleep with their sling on, so remember to remove your child’s sling before bedtime. Try and keep the injured area elevated for at least the first three nights (or longer if directed by your doctor) by using an extra pillow or folded blanket.
For tips on how to relieve itching and for more information about caring for a cast at home, see our fact sheet Plaster cast care.