Childhood is a time of boundless energy and exploration, which, unfortunately, can sometimes lead to injuries like fractures. Pediatric fractures are common, with a significant number of children experiencing these injuries each year.
Understanding the causes and implementing effective rehabilitation strategies are essential for promoting optimal recovery and minimizing long-term impacts on a child’s development and daily activities.
In this blog, we delve into the intricate world of pediatric fracture rehabilitation. We explore the causes and rates of fractures in children, highlighting the prevalence of such injuries and the most common scenarios leading to fractures.
Additionally, we provide a comprehensive overview of physiotherapy and occupational therapy interventions tailored to address the unique needs of pediatric patients.
Our aim is to offer valuable insights into the critical role that both physiotherapists and occupational therapists play in the recovery process, ensuring children regain their strength, mobility, and functional independence.
Whether it’s through targeted exercises, playful therapeutic activities, or the use of custom orthotics, these interventions are designed to support children in their journey towards full recovery and a return to their active lives.
Join us as we explore the essential aspects of pediatric fracture rehabilitation, from understanding the causes to implementing effective treatment strategies, ensuring the best possible outcomes for young patients.
Table of Contents:
- Causes and rates of fractures in children
- Physiotherapy interventions for the most common pediatric fractures
- Occupational therapy interventions for common pediatric fractures
- Conclusion
Causes and Rates of Fractures in Children
Overall, fractures occur in children at a rate of between 12 to 36.1 per every 1000 children. Looking at the breakdown between boys and girls, a greater predominance number of boys experience fractures at 42-64% compared to girls at 27-40%.
The most common cause of fractures in children is falls. Approximately one third of fractures occur due to sports injuries. Of all locations, the forearm close to the wrist, also known as the distal radius, is the most fractured bone of the body accounting for between 25-43% of all fractures in children.[i]
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Physiotherapy Interventions for the Most Common Pediatric Fractures
In the following section, we will focus on three of the most common pediatric fractures including wrist, ankle and upper arm fractures and how physiotherapy can play a vital role in the healing process:
Pediatric Wrist Fracture Treatment
Wrist (distal radius) fractures are the most common fracture in children as they account for between 25-33% of all childhood fractures. Most often, wrist fractures occur when children fall on an outstretched hand.
This type of fracture is quite painful and can cause symptoms such as tenderness and swelling around the area.[ii] When there is a wrist fracture, physiotherapy can help restore full joint movement and functional ability.
A study found that several different interventions were used by physiotherapists to treat wrist fractures. These included both active and passive interventions whereby active interventions involve techniques like exercise and education; and passive interventions consist of passive joint mobilization, where the therapist moves the child’s arms and hands without any muscle contraction made by the child.
Common active interventions for wrist fractures include exercise and the supervision of range of motion (ROM)/and flexibility exercises. As far as passive interventions, physiotherapists often practice passive joint movements, massage, and the use of compression sleeves.[iii]
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Pediatric Ankle Fracture Treatment
Similar to wrist fractures, ankle fractures are also very common among the pediatric population. Since children have very strong ligaments, injuries that would normally cause sprains in adults could lead to fractures in children.
Most often, ankle fractures in children occur due to a twisting motion during a ground level fall such as during playing sports or missing a step while using the stairs. Immediately following this type of fracture, the child will experience pain that becomes worse during weight-bearing. There may also be swelling or bruising around the area.
Normally, ankle fractures are treated with a cast worn for 4-6 weeks which is then removed and replaced with a walking boot. Physiotherapy would consist of low impact weight bearing and range of motion (ROM) exercises with and without resistance bands.[iv]
For any fracture involving the leg, foot, or ankle, the surgeon will set out specific timeline for how much weight the child is able to place on their fracture during the healing process.
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Weight Bearing Guidelines for Ankle Fractures
Following initial fracture treatment, it is important to follow medical guidelines regarding any weight bearing restrictions. Weight bearing involves carrying one’s bodyweight using one or both feet. Sometimes the surgeon will instruct the patient to be non-weight bearing meaning neither leg should touch the floor. Other times, partial weight bearing may be allowed at first and then progressed to full weight bearing over time.
When permitted, weight bearing exercises can help with endurance, balance, coordination, and overall health. One study recommended that weight bearing to increase bone mass should be done for at minimum 30-45 minutes at least 4 times per week. In fact, clinical studies have shown that low-intensity weight bearing is better than non-weight bearing in promoting bone healing.[v]
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Pediatric Elbow Fracture Treatment
Another common childhood fracture is that of the elbow (distal humerus) which is part of the upper arm close to the elbow. Elbow fractures occur mainly when a child falls on their palm with the elbow region extended and the arm away from the body.
These fractures mostly occur between the ages of 5 and 10 and make up almost 17% of all fractures in children. Normally, children will experience swelling, tenderness, pain and decreased range of motion (ROM) after the fracture occurs.
Children may be encouraged to begin physiotherapy two weeks after the cast is removed but this can vary from case to case. Physiotherapy can include resistance exercises, muscle re-education (movement), taping and electrical nerve stimulation depending on the specific type of elbow fracture.
Children may also experience difficulties with fine motor activities such as writing, holding and picking up objects. Occupational therapy can be very beneficial in regaining the strength and dexterity to complete these activities.[vi]
In summary physiotherapy treatment during bone healing can include:
- Strength training
- Range of motion exercises
- Joint mobilization
- Edema management
- Pain Management
- Stretching and strengthening of surrounding joints and muscles
- Gait retraining
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Occupational Therapy Interventions for Common Pediatric Fractures
Occupational therapy (OT) plays a crucial role in the rehabilitation of pediatric clients with fractures. OT interventions focus on promoting functional independence and improving the child’s ability to participate in daily activities. Below are some common OT interventions for pediatric fractures.
Range of Motion (ROM) and Strengthening Exercises
Structured ROM and strengthening exercises can significantly improve functional outcomes in children with upper extremity fractures. These exercises aim to restore normal joint movement and strengthen muscles affected by the fracture and immobilization period.
An example of an exercise that your child may perform with the OT could be crumpling a sheet of paper. This is fun and easy to learn and can be a great way of strengthening muscles in the hand following a fracture.
Splinting and Orthotic Management
Custom splints and orthotics are used to protect the healing bone, maintain alignment, and support functional use of the limb. Splinting is extremely useful since it can enhance recovery and prevent deformities.
When it comes to pediatric clients, OTs may opt to use colourful materials as this can quite calming and interesting to look at for the child making them feel more comfortable with wearing the splint.
Functional Task Training
This intervention involves practicing specific tasks that the child needs to perform in their daily life, such as dressing, feeding, and writing. Functional task training is used to improve ADL (activities of daily living) performance in children recovering from fractures.
Play-Based Therapy
Incorporating play activities promotes movement, coordination, and strength, which also helps to engage children and make therapy more enjoyable. Pain management is very important for pediatric clients since children may be more uncomfortable with the sensation of pain during therapy and recovery.
As a result, OTs must be extra creative with their interventions and find activities that children enjoy which can be incorporated into therapy. This can serve as a welcome distraction and enable children to participate more fully in their sessions.
Fine Motor Skills Training
These are activities that improve hand-eye coordination, dexterity, and fine motor skills, essential for tasks like writing and manipulating small objects. As such, fine motor skills training post-fracture can significantly enhance functional hand use in children.
Some examples of tasks that an occupational therapist may complete with a child include separating small pieces of LEGO and manipulating Play-Doh to create various shapes. This can be taken in a different direction when treating arm fractures as children may be asked to transfer small objects into a container which activates and strengthens both the hand and arm.
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Conclusion
Managing pediatric fractures requires a multifaceted approach, integrating both physiotherapy and occupational therapy to ensure comprehensive rehabilitation.
Physiotherapy interventions such as range of motion exercises, joint mobilization, and weight-bearing exercises are crucial for restoring movement and strength. Concurrently, occupational therapy focuses on functional independence through activities like strengthening exercises, functional task training, and fine motor skills development.
Our dedicated team of physiotherapists and occupational therapists (OTs) are well-equipped to provide specialized care for children recovering from fractures, ensuring they regain their functional abilities and return to their daily activities with confidence.
Whether through play-based therapy or the use of custom orthotics, our physiotherapists and occupational therapists are committed to delivering personalized and effective treatment plans tailored to each child’s needs.
References
[i] Gimigliano, F., Liguori, S., Moretti, A., Toro, G., Rauch, A., Negrini, S., & Iolascon, G. (2022). A systematic review of Clinical Practice Guidelines for the management of fractures in children to develop the who’s package of interventions for rehabilitation. European Journal of Physical and Rehabilitation Medicine, 58(2). https://doi.org/10.23736/s1973-9087.21.06916-1
[ii] Handoll, H. H., Elliott, J., Iheozor-Ejiofor, Z., Hunter, J., & Karantana, A. (2016). Interventions for treating wrist fractures in children. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.cd012470
[iii] Bruder, A. M., Taylor, N. F., Dodd, K. J., & Shields, N. (2013). Physiotherapy intervention practice patterns used in rehabilitation after distal radial fracture. Physiotherapy, 99(3), 233–240. https://doi.org/10.1016/j.physio.2012.09.003
[iv] Olgun, Z. D., & Maestre, S. (2018). Management of pediatric ankle fractures. Current Reviews in Musculoskeletal Medicine, 11(3), 475–484. https://doi.org/10.1007/s12178-018-9510-3
[v] Anderson, T. B. (2023, May 1). Weight bearing. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK551573/
[vi] Gashaw, M., & Yitayal, M. M. (2020). Physiotherapy Guideline for Children with Supracondylar Fracture of Humerus for Hospital Setting of Low-Income Countries: Clinical Commentary. Int J Phys Med Rehabil, 20(8), 1–5.
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