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Sprains versus breaks in kids: How to tell if it’s a broken bone or just a sprain

Sprains and broken bones can happen to kids year-round, especially during summer months. Whether an injury occurs from tree climbing or from a fall while running across a slippery pool deck, unless you are blessed with the powers of Superman and his X-ray vision, you won’t be able to determine whether it’s a broken bone or if it is just a sprain. That being said, there are many clues that can help steer you toward a probable diagnosis.

Location: Pain and swelling that occur in the middle region of a bone (away from either joint) are more likely to indicate some type of break. Pain and swelling at a joint can be either a fracture (break) or a soft-tissue sprain.

Deformity: Any sign of change 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 direction of a body part can be a fracture/dislocation or a soft-tissue sprain.

Mechanism of injury: Injuries occur from several different mechanisms, most commonly a direct impact or a twisting injury. Fractures are more likely to result from a direct impact, and twisting injuries more often produce soft-tissue sprains or tears; however, it’s important to note that fractures can sometimes occur from twisting action.

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. The ability to bear weight or use a body part with pain lowers the chance of a fracture.

The one characteristic that makes children different from adults — and even more challenging to diagnose injury — is that they 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 one sign that does little to help differentiate between fractures and sprains, since bruising can be caused by either injury.

If your child has sustained a break, you may hear that the fracture is displaced, meaning the bone ends do not line up, or nondisplaced, meaning that they are lined up. You may also hear that the fracture is open, if the bone is showing through the skin, or closed, if there is no break in the skin. The fracture may also be comminuted, meaning that it broke into more than two pieces.

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

If you believe your child has sustained a break or major sprain, he or she may need immediate medical attention from a primary care provider or your local emergency department. To learn more, visit mount nittany.org/specialties-and -services/pediatrics.

Caryl Waite is a physician assistant at Mount Nittany Physician Group.

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