News | Published September 19, 2012

Broken bone or just a sprain? How does a parent know?

Unless you were blessed with the powers of Superman and his x-ray vision, you won't be able to determine whether an injury to your child involves a broken bone or just a sprain. That being said, there are many clues that can help steer you towards a probable diagnosis.

  1. Location: Pain and swelling that occurs in the middle region of a bone - away from either joint - are more likely to be some sort of break or fracture. Pain and swelling at a joint can be either a fracture or a soft tissue sprain.
  2. Deformity: Any sign of deviation from the normal anatomic structure of a body part is a clear sign of fracture or dislocation. Swelling at a joint that doesn't alter the normal anatomic structure of a body part can be a fracture, dislocation or a soft tissue sprain.
  3. Mechanism of Injury: Injuries occur from several different mechanisms, most commonly a direct impact or a twisting injury. Fractures are more likely from a direct impact, and twisting injuries are more commonly soft tissue sprains or tears. But, keep in mind; fractures can occur from twisting action also.
  4. Weight Bearing and Use of Injured Body Part: If the child is unable to bear weight on the injured leg or unable to have any use of an upper body part, that increases the likelihood of a fracture. If they can bear weight or use a body part - even with pain - it lowers the chance of a fracture.

The one characteristic that makes children different and even more challenging to diagnose, in terms of injury, is that children have growth plates at the end of all the long bones. These growth plates are formed of cartilage and are very prone to injury, as they are weaker than all the other structures that support the skeleton (bone, ligaments, and tendons). Because of this weakness, growth plate fractures are common in children and can occur even with typical sprains and strains. Bruising is another sign seen in injuries but can be caused by both fractures and sprains, so does little to help differentiate between the two.

In terms of getting injuries evaluated by your pediatrician, all injuries that involve deformity, significant swelling, or an inability to bear weight or use an upper appendage should be checked. This is especially true for children with open growth plates, namely every child who hasn't finished growing. An x-ray - done by a healthcare professional and not Superman - remains the best way to check for fractures and assess the growth plates in the area of injury.