Unless you intend to keep your offspring locked up in the house forever, sheltering them from the outside world is not only impossible, but also ill-advised. Children need to be exposed to positive and negative stimuli alike to have a wholesome development. Unfortunately, letting them inspect the outside world means they might get hurt in the process of exploring, and incur serious injuries such as fractures. However, you do not need to be helpless when your heir breaks a limb. Here are some meaningful ways and tips that might help you the next time he or she gets too playful.
Kids Wrist, Elbow & Knee Fractures – How to tell?
It is easy to tell if a fracture is in play, especially for kids’ elbow fracture and kids’ knee fracture. The easiest way to gauge an injury is to observe the response of your child. If he is screaming and crying, it is likely that he has sustained a heavy injury. There would have been a ‘snap’ sound as well.
Look out for signs of swelling (inflammation) and deformity. If there is a bump or even an exposed bone, it is likely a fracture. However, just because there is no sign that something has gone wrong does not mean things are okay. With some types of fractures, the broken bone remains in place, i.e. it rests aligned with its original position. If unsure what is going on, seek medical advice immediately.
Kids Wrist, Elbow & Knee Fractures are Common Injuries
Kids wrist fracture, kids elbow fracture and kids knee fracture are some of the most common types of fractures around. This is due to the fact that one has a natural urge to lift up their arms when falling. However, this does not mean that these are the only areas where a fracture occurs! Fractures can happen anywhere, especially on the knee. Think of ‘key’ places where kids usually land on when they fall. Kids knee fractures are very common due to the sports we play in Singapore as well (basketball, soccer etc.)
Types of elbow fractures:
- Monteggia fractures.This is when the radial head has moved out of place from the elbow joint.
- Supracondylar humerus fracture. This is the most common injury affecting the elbow. It happens in the humerus, hence the name. If the fracture is severe, surgery might be required. Any dislocation will have to be fixed before a cast is applied. If the doctor does not put the bone in place and it heals that way, deformity and growth problems will ensure.
- Condylar fracture. It occurs above the elbow, right in the humerus. The difference between this and supracondylar fractures is that the former involves the surface of the joint.
- Physeal fractures. It can occur in the ulna, radius, or ulna bones. It usually affects the growth plate.
- Epicondylar. It can happen at either tip of the bony protuberance in the elbow.
Type of knee fractures:
In most cases, an injury in this part of the body can affect the tibial tubercle, plateau, eminence, or condyle. A fracture is also likely to occur in the patella (the kneecap). This is a very painful experience that can make it difficult to walk or straighten your knee. Needless to say, such injuries need to be treated with extra care.
Types of wrist fractures:
The most commonly occurring wrist fractures in kids are the greenstick and buckle fractures. The former leads to a partial injury in one part of the bone, which causes it to bend on the other side. The latter happens on one side of the bone only. Here, the damaged pieces of bone have not been displaced.
Kids wrist, knee and Elbow Fracture – Immediate Steps to Take
Firstly, ensure the affected area is not moved until it is attended by medical staff. Do not touch any open wounds unless there is severe bleeding. Immobilize the wound, and apply ice to the affected area (do not apply ice directly onto the skin, use a cloth) but not on the wound itself. This will minimise inflammation and swelling, and consequently pain. If you can make a makeshift splint to immobilize the wounded area, do so. This is especially helpful during a kid’s wrist fracture or elbow injuries as children tend to fidget even when wounded.
Secondly, bring your child to a hospital. Use your personal vehicle to do so, and only call an ambulance if you are not with your child and he cannot be driven to the hospital. There are different kinds of fractures, and only trained medical staff can decide what is the next best course of action. The 3 common areas of fracture, kid’s wrist fracture, elbow fracture and knee fracture, all have different types of treatment options. Usually, after an X-ray is taken, and an injury is elucidated fully, a doctor can decide what to do. Typically, the bone is set after local anaesthesia is injected, and a cast is placed to help your child support his arm. The bone then fully heals after 1-3 months.
Pediatrics for Kids Elbow, Knee and Wrist Fracture
It is also a good idea to go to a pediatric for an opinion since they are specialists who have tons of experience in dealing with fractures in children. Usually, a doctor is the first option right after a fracture but there are specialists pediatric doctors who are open 24 hours for such emergencies. It is actually wiser to go to them for hospitals (especially NUH and SGH are very crowded, often even TTSH A&E) have a long waiting time. Compared to some of their common A&E patients, your children might not see priority too because fractures aren’t usually regarded as “emergency” when compared to chest pain and breathing difficulties.
It is vital to keep yourself calm if an accident happens. Remember, your child would be in an even more delirious state than yourself. Assuage your child by comforting him, and promising him that you will cook his favourite meal later.
Nursing my child suffering from Kids Elbow, Knee or Wrist Fracture?
Be sure to help your child dress and clean himself while he is recovering, as it is extremely likely that he or she has a limited range of motion. This is also due to the fact that water must not enter the cast at all, or moisture may build up, resulting in a potential infection. It is usually recommended that a protective bag be placed over the cast to prevent water from entering it. For kids’ wrist fracture and elbow dislocation, it is useful to take away their attention with some TV or video as this lowers their chances of moving their arms unnecessarily. For kid’s knee fracture, he is usually going to be immobilized on bed or wheelchair for quite some time, unfortunately.
If your child feels itchy, utilise baby wipes or baby powder to quell the itching. You can also use a wet cloth to wipe your child if it is inconvenient for him to take a shower.
Be sure to give your child guidance on what not to do. He might not be aware that he needs to avoid applying force on his injury, or may put himself at risk by watching his friends play soccer.
When the fracture heals fully, your little one will need physical therapy to help gain back full range of motion.
Understanding Growth Plates and Why They Matter for Fractures
One of the most important differences between fractures in children and adults is the presence of growth plates — also called physes — at the ends of long bones. These are zones of cartilage where bone elongation occurs. Because growth plate cartilage is softer and weaker than mature bone, it is vulnerable to injury. A force that would cause a ligament sprain in an adult may instead fracture through a growth plate in a child.
The Salter-Harris classification system describes five types of growth plate fractures, from Type I (separation through the growth plate only) to Type V (crush injury of the growth plate). Higher Salter-Harris types carry greater risk of affecting bone growth. A Type V injury, for example, can cause premature closure of the growth plate, resulting in a shorter or angulated limb. This is why any suspected growth plate injury in a child should be assessed by a paediatric orthopaedic surgeon rather than managed as a routine adult fracture.
Fortunately, children’s bones also have remarkable healing and remodelling potential. Young bone has a thicker periosteum (the outer layer of bone) and more active bone-forming cells, meaning fractures typically heal faster and with less intervention than equivalent fractures in adults. Minor degrees of angular deformity in long bone fractures in young children often correct themselves over time through the remodelling process.
The Difference Between a Fracture and a Sprain — And Why It Matters
Parents frequently ask how to distinguish between a sprain and a fracture in their child without an X-ray. The honest answer is that it is often not possible to do so clinically, particularly around growth plates. A child with point tenderness directly over a bone — especially a growth plate — and significant swelling has a fracture until proven otherwise by imaging. Attempting to assess whether a joint is “moving normally” is not a reliable way to rule out fracture in a child.
The wrist is a classic example. A child who falls on an outstretched hand and has wrist pain and swelling may have a sprain, a distal radial growth plate fracture (Salter-Harris Type I or II), a scaphoid fracture, or a buckle (torus) fracture of the distal radius. Each requires different management. X-ray is the minimum required investigation — and even then, some fractures (particularly scaphoid fractures) may not be visible on initial X-ray and require MRI for definitive diagnosis if clinical suspicion is high.
What to Expect at Each Fracture Follow-Up Appointment
Most fracture follow-up schedules in Singapore involve clinic reviews at one to two weeks, three to four weeks, and six weeks after injury. At the first follow-up, the doctor assesses initial healing and checks that the fracture position has not shifted — particularly important in the first week after closed reduction. Repeat X-rays are taken to confirm alignment. If a cast has been applied, the doctor checks for cast-related complications: pressure sores, skin breakdown, neurovascular status.
At three to four weeks, significant healing is expected for most paediatric fractures, and the cast may be removed or replaced with a lighter splint. By six weeks, most simple fractures are clinically and radiologically healed, and the child is cleared for progressive return to activity. Growth plate fractures require extended follow-up — typically at three months and again at six to twelve months — to confirm normal growth resumption and detect any early deformity.
Physiotherapy After Wrist, Elbow, and Knee Fractures
The need for physiotherapy after fracture varies by site and severity. Wrist fractures in young children generally do not require formal physiotherapy — children regain full function naturally through play and daily activity within weeks of cast removal. However, wrist fractures in older adolescents, particularly those with prolonged immobilisation or associated soft tissue injury, may benefit from guided exercises to restore grip strength and range of motion.
Elbow fractures are the most likely to benefit from physiotherapy guidance, as the elbow is prone to stiffness after immobilisation. Aggressive manipulation is avoided (due to the risk of myositis ossificans), but gentle, progressive active-assisted range of motion exercises can be initiated under the guidance of a physiotherapist once the fracture is healed. Full elbow extension may take three to six months to return, and a small permanent loss of extension is common but usually not functionally significant.
Knee fractures involving the tibial spine or growth plate often require physiotherapy to rebuild quadriceps strength and restore full range of motion and proprioception after immobilisation. The physiotherapist works with the orthopaedic surgeon to ensure the rehabilitation programme is appropriate for the fracture type and stage of healing.
Frequently Asked Questions
Can my child’s broken wrist heal without a cast?
Most wrist fractures in children require some form of immobilisation to heal in correct alignment. Buckle (torus) fractures — the most common type in young children, where the bone bends and buckles on one side without fully breaking — can sometimes be managed with a removable splint rather than a rigid cast, as they are inherently stable. More significantly displaced fractures require rigid casting or surgical fixation. Your orthopaedic surgeon will determine the most appropriate immobilisation based on the X-ray findings.
How do I keep my child’s cast dry during bathing?
A waterproof cast cover (available at pharmacies and medical supply shops in Singapore) is the most reliable solution. These are reusable and create a watertight seal around the cast during showering or bathing. Alternatively, a plastic bag sealed tightly with tape provides a temporary solution for short periods, though it is not as reliably waterproof. If a plaster cast gets thoroughly wet, it must be assessed by your doctor as it may need replacing — a wet plaster cast loses its structural integrity and can cause skin problems.
When can my child return to PE after a fracture?
PE exemption is typically maintained until the fracture is confirmed healed on X-ray and the doctor has cleared the child for physical activity. For most simple fractures, this is six to eight weeks after injury. A graded return — starting with non-contact activities and progressing to full participation — is safer than an abrupt return to full sport. Request a medical letter from your orthopaedic surgeon for the school specifying when full PE participation is appropriate.
