Sprain or Broken Bone? What Parents Should Know

Your child comes off the field holding a wrist, or limps in after a trampoline jump. Is it a sprain, or is something broken? Often even doctors cannot tell until an X-ray is taken. Here is how to think it through, what to do in the first hours, and when your child needs to be seen.

Sprains, strains and fractures: what is the difference?

• A sprain is a stretch or tear of a ligament, the tough band that holds bones together at a joint. Ankles, knees and wrists are common spots.
• A strain is a stretch or tear of a muscle or tendon. Hamstrings and calves are frequent examples.
• A fracture is a broken bone. It can be a small crack or a complete break.

Children's bones are softer and bend more than adult bones, so kids can have fractures that look different. A "buckle" fracture is when one side of the bone squishes in. A "greenstick" fracture is when the bone bends and cracks on one side, like a fresh twig. These can hurt less than you might expect, so a child may still use the arm or leg.

Growth plates: why kids are different

Near the ends of a child's long bones are growth plates, areas of growing cartilage that later turn into solid bone. Growth plates are weaker than the ligaments around them. That means an injury that would be a sprain in an adult is sometimes a growth plate fracture in a child.

Most growth plate injuries heal well with proper care. A few can affect how the bone grows, which is why doctors take pain near a joint in a growing child seriously and may want to recheck it over time.

Signs that point toward a broken bone

No single sign rules a fracture in or out, but these make one more likely:

• A bone that looks bent, crooked or out of place
• A snap or pop heard at the time of injury, along with sharp pain
• Pain right over the bone when you press gently, not just in the soft tissue
• Swelling and bruising that come on quickly
• Your child refuses to put weight on a leg or won't move an arm
• Pain that keeps a child up at night or gets worse over a day instead of better

A sprain also causes swelling, bruising and pain, but many mild sprains feel noticeably better within a couple of days.

Very young children cannot always tell you what hurts. A toddler who suddenly stops walking or will not use one arm after a fall should be checked, even if there is little swelling.

First aid at home: rest, ice, compression, elevation

For a mild injury where nothing looks out of place, the familiar steps help ease pain and swelling in the first day or two:

1. Rest. Stop the activity and keep weight off the injured part.
2. Ice. Wrap ice or a cold pack in a thin towel and apply for about 15 to 20 minutes at a time, several times a day. Never put ice directly on skin.
3. Compression. A stretchy bandage can limit swelling. Wrap it snug but not tight. If fingers or toes turn pale, blue, cold or numb, loosen it.
4. Elevation. Prop the injured arm or leg on pillows so it sits above the level of the heart when possible.

For pain, acetaminophen or ibuprofen can help. Ask your pediatrician or pharmacist for the right dose based on your child's weight. Do not give aspirin to children.

If you think the bone might be broken, do not try to straighten it. Keep the limb still, support it in the position you found it, and get medical care.

When does my child need an X-ray?

Your child should be seen, and will likely need an X-ray, if:

• Any of the fracture signs above are present
• They cannot bear weight or take a few steps after the injury
• Pain or swelling is not improving after a day or two of home care
• The pain is right at a joint in a child who is still growing

Some fractures, especially small ones at growth plates, do not show up clearly on the first X-ray. If pain continues, your child's doctor may treat it like a fracture anyway and recheck it in a week or two. The MedlinePlus page on fractures explains how breaks are diagnosed and treated.

Splints and casts

A splint is often used first. It supports the injury but leaves room for swelling, which is usually worst in the first few days. Some fractures are then moved to a cast, and some, like many buckle fractures of the wrist, heal fine in a removable splint or brace.

Cast care tips:

• Keep it dry unless your doctor says it is waterproof. Cover it with a plastic bag for baths.
• Never stick anything inside to scratch an itch. Try blowing cool air from a hair dryer on the cool setting.
• Prop the limb up for the first few days to limit swelling.

Call right away if fingers or toes become numb, tingly, very swollen, pale or blue, if pain gets much worse, or if the cast smells bad, gets wet inside or cracks.

Getting back to sports

Children often feel ready before the injury is fully healed. Returning too soon can lead to a second injury. In general, a child is ready to return when:

• Their doctor has cleared them, especially after a fracture
• They have full or nearly full motion and strength compared with the other side
• They can run, jump, cut or throw without pain or limping

Some kids benefit from a few weeks of physical therapy or a home exercise plan. For ankle sprains, balance exercises can help lower the chance of spraining it again. You can read more about sprains and strains on MedlinePlus and about what to do after a sports injury on HealthyChildren.org.

When to call us

Call your A thru Z Pediatrics office if your child has pain near a joint, a limp, swelling that is not getting better after a day or two, or pain that wakes them at night. We can help decide whether an X-ray is needed.

Call 911 or go to the ER if a bone is pushing through the skin, a limb looks clearly bent or out of place, the hand or foot below the injury is cold, pale, blue or numb, there is heavy bleeding, or the injury came with a head, neck or back injury.

Want your child checked? Request a visit.