Broken Bones and Dislocations in Children

Let’s talk about dislocations and breaks and what can happen in children. This is also something we teach and go through quite extensively in our first aid classes. We will discuss what to expect, what to do, what first-aid to give and the difference between a dislocation and a break.

Dislocation

A dislocation is when a joint falls out of the socket.

The most common part of the body to get dislocated is the elbow. This can occur when we are swinging our children around by the arms (this actually happened to me when I was a child!), or when you are standing on the side of the road and pull your child back quickly by their arm.

If dislocation happens often, the joint can become weak, which is something we need to be aware of.

Treatment for a dislocation:

• Support the arm with a simple triangular bandage. You can use a large square muslin or sheet, make it into a triangle and pop the point of the triangle underneath the elbow. Both ends of the triangle go over the shoulders, to tie at the back behind the neck.

• A dislocation does need treatment relatively quickly because it will be very uncomfortable. The most likely scenario is that your doctor or the emergency department will be able to pop that joint in quickly and quite easily.

There are usually no long-term effects with dislocation.

If dislocation happens often, the joint can become weak, which is something we need to be aware of.

Breaks / fractures

With any child under the age of one that is brought into the hospital with a fracture – there is usually some questions around it because babies’ bones tend to be quite flexible up to the age of 18 months because they are made of a lot of cartilage which makes them a bit more tricky to break.

This is something our medical professionals must do to protect children on that odd occasion when it isn’t an accidental injury.

Older children will always be able to tell you when there is some sort of injury and explain what has happened to cause the injury which can help you to assess the injury.

It can be difficult to identify a fracture in toddlers and infants – they might cry, you might not see the affected area and there may be no obvious injury either. Babies and, toddlers especially, will mask an injury, by just thinking ‘my left arm is really sore, so I’ll just not use it, I’ll go play with my right arm’.

Especially in a multi-child household, these things are not noticed that quickly and it happens often that a child comes in and the fracture happened a day or two earlier.

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

• Pain or tenderness around the injury;

• Swelling or redness around the injury (with swelling comes pain which is why we like to elevate the arm);

• Deformity or an unusual shape of the injured area (you can ask your child to put both legs out or both arms to compare the difference);

• Not wanting to move or use the injured area.

First aid treatment for a fracture is to provide comfort for the child, help to reduce the swelling and provide the child with some pain relief until the fracture is treated which should be relatively quickly.

You can apply the following first aid for a suspected fracture, and then seek medical help:

• Give some pain relief in the form of paracetamol, ibuprofen or both;

• Reduce movement of the affected area, you can apply a splint or a sling to an arm, putting on the triangular bandage to support the arm and keep it in one place. If it is a leg, you need to be very careful about moving the child. If it is comfortable enough to elevate the leg it may be ok to elevate, but usually, with a leg fracture, you need to call the ambulance, because moving the child will be very difficult.

• Apply an ice pack to the affected area. Remember to always make sure that the ice pack is wrapped in something so it is not directly on the skin.

• Elevate – you can elevate the arm on route to the hospital. If you don’t feel comfortable, if you think the break is very obviously deformed and you can’t move your child then you can call an ambulance.

• With an open fracture or a compound fracture (when there is bone sticking through the skin) we don’t know what ligaments, muscles, nerves or tendons are involved. DO NOT move this child, call an ambulance. You can still give some pain relief and perhaps cover the injury with a very light muslin if the child is getting distressed looking at it. The ambulance can assess the damage on arrival and also give stronger pain medication.