Childhood Injuries: Sprain vs. Fracture

“I can’t move my arm!” “It hurts when I walk!” If you have active kids, you’re used to them telling you (dramatically) about all their bumps and bangs. Most of the time, they brush it off and a few minutes later are back on the monkey bars or sliding into first.

But sometimes, it’s not just dramatics — you’re worried something may actually be broken. Since you haven’t developed X-ray vision eyes (well, YET), how can you tell if it’s a sprain or a fracture?

Orthopaedic specialist Michael Star, MD, breaks down the difference — and explains when it’s time to enlist a doctor’s help.

What is a fracture?

Put simply, fractures are broken bones. And broken bones come with one or more of these telltale signs:

• Pain and swelling.
• Deformity (“If something’s pointing in the wrong direction, it’s pretty obvious it’s a fracture,” notes Dr. Star.)
• A crunching sensation or sound.
• Numbness or tingling (“This can happen with sprains, too. But these feelings often indicate a more significant injury that a doctor should look at earlier.”)
• Trouble bearing weight on the affected body part (“If you can’t walk on your leg, for example, it’s more likely a fracture.”)
• Tenderness when you push on the bone.

What is a sprain?

A sprain is a ligament injury. Ligaments are the soft tissues that connect two (or more) bones at a joint, such as the ankle, knee or elbow.

While the signs of a sprain are often less obvious than fracture symptoms, there is some overlap:

• Pain and swelling.

Tenderness in your soft tissue (“If you look at the back of your wrist on the pinky side, there’s a bone that sticks out a little bit. You can also push down on the thumb side and feel a bone there. If you have a sprain, it will feel swollen and tender all over the wrist and not just on the bone parts,” explains Dr. Star.)

How to handle a sprain: RICE it!

You can give the injury three days to improve if:

• It’s not that painful.
• Your child can move the injured joint normally.
• Your child has the same pre-injury strength and sensations in the injured area.
• Nothing is out of alignment.

Follow the RICE acronym for the first 24 to 48 hours to give your child some relief:

• Rest: Limit activities that use or put pressure on the injured area.
• Ice: Put ice on it as soon as you can. The general rule is to apply ice or a cold pack four to eight times a day for 20 minutes. To avoid adding frostbite to your list of concerns, wrap whatever you use in a towel.
• Compression: Wrap the injury in an elastic bandage to reduce the swelling.
• Elevation: Rest the injured area on a pillow higher than your child’s heart.

“If the swelling gets better and it’s less tender within a couple of days, your child is most likely OK,” relates Dr. Star. “But if it doesn’t get better within two to four days, then you should see a doctor.”

When in doubt, get the injury checked out

When it comes to sprains, kids aren’t adults in miniature. While some adults can tough it out, Dr. Star advises against using that approach with children.

“Kids can injure something called the growth plate. That can affect how they grow over time. So parents should treat their children’s potential sprains more rigorously than they would their own,” says Dr. Star. “Any child who’s still growing should be evaluated to make sure they don’t have a fracture. And the only way to rule one out is to get an X-ray.”

Dr. Star also emphasizes the need to see a doctor if a significant cut or other wound accompanies the injury. “The wound may need to be addressed separately. It also may need to be treated more aggressively with antibiotics and cleaning.”

What type of doctor should you see? Any doctor that can provide a basic evaluation and take an X-ray. Medical facilities that provide these services include:

• Primary care or pediatrician offices.
• Urgent care centers.
• Emergency rooms.