Twist and shout, ouch! Shin fractures and playground slides

July 31, 2017

Summer is here.  The sun is shining, at least a bit, and kids are hankering to be outside, at the park, running around, being kids. Good, clean, healthy fun. Most of the time.
 
Parents might not realize it, but thousands of children are hurt each year on the playground.

As a pediatric orthopedist and a parent, I’m all too aware of the injuries sustained by children falling off of monkey bars. My daughter broke a wrist falling from them when she was 6.

Slide injuries on the rise

But monkey bars will be the topic of another blog post. In this post, I want to raise awareness of another injury that may not be on the radar of parents of small children. While there are no national statistics available, it seems like more young children are injuring their legs on playground slides. 

This spring, I cared for a surprisingly large number of toddlers with fractures of the tibia, or shinbone, from riding on slides. What might surprise parents is that almost all of these children sustained their injuries while riding on the lap of an adult. 

Riding with a parent could be the problem

How can this happen? This seems counterintuitive. Isn’t a child safer riding on a slide with a parent? Not in this scenario: 

What seems to happen is that a child’s shoe, which usually has a rubber or traction sole, makes contact with the slide, abruptly stopping the movement of the child’s leg and fixing it in place. The adult’s momentum puts significant pressure on the child’s leg and causes a twisting, or torsion, injury called a “spiral fracture,” or a compression injury called a “buckle fracture".

A 2009 study in the Journal of Pediatric Orthopaedics looked at tibia fractures over 11 months at one New York hospital. Of the 58 pediatric tibia fractures identified, 13 occurred on playground slides. And all 13 involved children younger than 3 who were riding on the lap of an adult or older child. 

How to tell if a child has a tibia fracture

Shin fractures hurt. They will typically cause a child to cry right away, and usually more and longer than everyday bumps and tumbles. You will probably be able to soothe and calm your child, but she might not want to walk on her injured leg. If she reverts to crawling, an injury is likely.

Still, it may be difficult to believe your child has broken a leg. The leg may not be swollen or bruised, and your child may not complain about pain if you touch, move or examine the limb. But with a break, your child won’t be comfortable. 
With more significant injuries, children will not even put their legs down to touch the floor. Other children, with subtler injuries, may try to bear weight, but they may limp and avoid walking if they can. 

Expect a quick recovery

An X-ray may well reveal a fracture of the tibia or another bone of the lower leg. Fortunately, for the vast majority of children, there will be no long-term repercussions from a tibia fracture. 

These fractures in children typically heal within a few weeks.  Children usually are most comfortable and protected with a cast. For tibia fractures, a cast that extends from the toes to the top of the thigh is recommended. The cast is usually removed after three to four weeks, and children are back on their feet within a few days. It’s not uncommon for them to limp for a few weeks, however. 

Watch for signs of skin sores

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Although they start off as comfortable, splints and casts can move and slide, causing skin sores. This is especially true with active toddlers, who often don’t have the words to say that something is bothering them underneath their splint or cast. I have seen a number of children who were actually quite comfortable once they had a cast or splint, only to become uncomfortable and fussy after several days. 

When parents bring these children into the clinic, we will remove the splint or cast to see what’s going on. Sometimes these children have pressure sores caused by rubbing or excessive pressure. 

These skin sores usually heal well, but can leave significant scars. If your child has a splint or cast that seems to be slipping or shifting, or she seems to have become much fussier or uncomfortable, contact the health care provider who applied the splint or cast so it can be removed to check for sores.
 
Here are some takeaways and advice for parents with active toddlers:

Pay attention to the age recommendations at playgrounds. The best approach may be to direct smaller children away from playground activities designed for older kids. Smaller children do not have the motor control to handle the increased force generated on bigger play structures. It’s hard for small hands to hold on, or to catch or stop an object in time. If you choose to let a younger child try the slide, put the child on alone, only part of the way up, and stand beside the child. If you feel you must be on the slide with your child, it may be safer to take shoes off.   
 
If your child is unable to bear weight or has a persistent limp after an injury, get an evaluation by a health care provider. Children’s bones are softer than those of adults. This means children are much more likely to break a bone than to sprain something. If your child cannot bear weight or is limping for more than a few hours after an injury, a bone fracture is possible. 
 
If your child’s splint or cast is slipping or shifting, call your provider. Increased pain or fussiness could indicate skin problems because of undue pressure. Have your child checked for skin sores.
 

Has your child had a playground mishap that made you think twice about a play structure? Share your story in our comments section.

Topics: Kids, Orthopedic