From
StayCurrentMD
Most Common Pediatric Fractures and How to Prevent Them by Dr. Jill Larson
With Dr. Jill Larson
Chapter 1 of 15
Introduction
Introduction to pediatric fractures grand rounds
Expert statements on this page
No expert statements were drawn from this page.
Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
Intestinal Atresia Types Explained: Grossfeld Classification for Pediatric Surgery
1 min · Published Sep 2026
Video
Derivation and validation of the Pediatric Community-Acquired Pneumonia Severity (PedCAPS) score: A prospective cohort study
50 s · Published Sep 2026
Video
FETO for Late-Diagnosed Severe Congenital Diaphragmatic Hernia (CDH) at Cincinnati Children's with Dr. Beth Rymeski
4 min · Published Sep 2026
Video
Severe Congenital Diaphragmatic Hernia (CDH) Case: FETO Management & Unexpected Findings with Dr. Beth Rymeski
3 min · Published Sep 2026
Video
Fetoscopic Endoluminal Tracheal Occlusion (FETO) Procedure: Step-by-Step Guide with Dr. Beth Rymeski
4 min · Published Sep 2026
Video
Choledochal Cyst Types Explained: Pediatric Surgery Fundamentals
1 min · Published Sep 2026
What the experts said
Fracture rates increase starting in March until peak in August, with a spike at Lurie Children's in October likely due to return to school with less supervision and increased athletic participation.
The most common location for a pediatric fracture is the distal radius or wrist fracture.
Extra-physeal fractures have a low risk of physeal growth plate arrest or damage to longitudinal growth of the arm.
The closer the fracture is to the physis, the increased potential for remodeling of any residual deformity.
Intra-physeal fractures need to be closely monitored as there can be early closure or growth plate arrest during the healing process.
A buckle fracture that is non-displaced heals very reliably in approximately three to four weeks depending on age.
Recent studies have demonstrated that fracture healing rates are similar in a removable splint versus a cast for buckle fractures.
A removable splint can be applied in an urgent care setting for buckle fractures and follow up with a pediatric orthopedic surgeon may not be needed.
Waterproof casting must get wet daily to prevent skin excoriation.
In children greater than age 10, near anatomic reduction is imperative because of the remodeling potential left in the distal forearm.
Children greater than 10 years of age can still have recurrence of displacement even with appropriate immobilization.
Displaced fractures in children over 10 should be seen within three to five days of casting as they sometimes need repeat reduction and intraoperative stabilization.
A second physeal injury can occur with reduction of physeal fractures.
If anatomic reduction is not successfully achieved on the first attempt for physeal fractures, treatment in the OR for closed reduction is recommended to minimize additional trauma and physeal growth arrest.
Due to physeal injury, a six month follow up with an x-ray is recommended to assess for physeal growth arrest.
The physis in children is often the weakest part of the bone, even weaker than the ligaments or tendons themselves.
The most common ankle fracture in kids is a distal fibular physeal fracture.
Distal fibular physeal fractures should be non-weight bearing to prevent further injury to the physis.
Children under the age of 10 may need a walker for stabilization of ankle fractures, while children over 10 can typically mobilize with crutches or a knee scooter.
In very displaced fractures, it is critical to do a reduction maneuver to take off pressure on the skin, as the bony spike can cause soft tissue or skin necrosis and ultimately lead to an open fracture.
Triplane fractures occur most often in the older teenage population and require advanced imaging such as CT scan to better identify exact displacement and joint surface involvement.
If displacement of the joint surface in a triplane fracture is more than two millimeters, open reduction and internal fixation with a positional screw is required.
A toddler's fracture (non-displaced spiral fracture of the tibia shaft) is very common in children ages 9 months to 3 years old.
In children with limited verbal skills, there is a high risk of heel ulceration when the leg is placed in temporary splints.
Close follow up with a pediatric orthopedic surgeon three to five days after initial injury is imperative to ensure skin is appropriately decompressed, especially over the heel.
Both bone forearm fractures are at high risk to develop compartment syndrome due to swelling and soft tissue trauma.
Providers should have high suspicion for compartment syndrome if a pediatric patient has increasing agitation, anxiety, and analgesic requirements after closed reduction and casting.
There is an increased risk of refracture of both bone forearm fractures within the first six months.
Flexible nails for both bone forearm fractures are typically removed 6 to 12 months after healing to avoid the high risk of refracturing within the first six months.
Obese or overweight children are at higher risk for fracture, primarily due to increased stress on their bones and secondarily due to inactivity or immobility.
Obese children have increased complications of fracture management due to implant failures or fracture malunions.
Children with vitamin D insufficiency have a fracture risk that is three times greater than a vitamin D sufficient child.
The American Academy of Pediatrics recommends 1,000 milligrams of calcium per day and 1,000 international units of vitamin D daily for ages 4 to 8 years.
Each year, 200,000 children injure themselves on playgrounds in the United States and another 200,000 get hurt on trampolines alone.
More than 176,000 children ages 5 to 14 are treated each year in hospital emergency rooms for injuries related to skateboards, scooters, and skates.
Most playground injuries are caused by a fall from the monkey bars onto an outstretched hand, which causes a forearm or an elbow fracture.
The American Academy of Pediatrics recommends that children under 5 years old should not ride a skateboard.
The American Academy of Pediatrics recommends that children younger than 8 years old should not use a formal two-wheeled scooter.
In 2016, more than 4,500 children in the United States were treated in emergency departments for injuries related to lawn mowers.
Children should be at least 12 years of age or older before operating a push lawn mower and 16 years or older to operate a riding lawn mower.
Talking on a phone accounted for 69% of injuries between 2004 and 2010, and texting for 9% of injuries during the same period.
The most common fracture at the elbow is a supracondylar humerus fracture.
Type one supracondylar fractures are non-displaced and treated with a long arm cast for three to four weeks.
Type two supracondylar fractures are displaced with a cortical hinge posteriorly intact and treated with closed reduction and percutaneous pinning followed by three to four weeks of casting.
Type three supracondylar fractures have complete disruption of the posterior cortex, are often widely displaced with increased risk of neurovascular compromise, and are treated with closed or open reduction and percutaneous pinning.