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Presentation
Problem
Method
Research
Data
Conclusion
Citations
Acknowledgement
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The Bones We Break

Determine which bones children ages 0-18 break the most and what is the main cause.

Chenaya Senadheera

Grade 9

Presentation

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Problem

Question:

Which bones do children break the most often and what is the main cause?

Hypothesis:

If a child falls then they are susceptible to a bone fracture in the upper limb because the natural response to a fall is often to extend the hand.

Objective

The objective of this study is to find out

Which bones do children fracture the most often?
1. Neck and up
2. Entire arm
3. Entire Torso
4. Entire leg
Do most bone fractures occur as a result of a fall?
What is our natural response to a fall?
Are children who play sports more susceptible to bone fractures than those who don’t?
Test the validity of the hypothesis

Method

Completed a literature review to collect background information on:
- What are the bones in the human body
- Is a bone fracture different from a bone break?
- What are the types of common youth bone fractures?
- What is our natural response to a fall?
- collecting four data sets from reputable sources in the literature to test the hypothesis

Two procedures were used to test the hypothesis:

Procedure 1: Conducting a study which collects data using a survey questionnaire.

Procedure 2: By analyzing four data sets from reputable sources

Procedure 1: Conducting a study which collects data using a survey questionnaire.

The survey questionnaire focused on the following:

Whether a bone fracture happened between 0- 18 years old

The location of the bone fracture

Reason for the bone fracture

How could have avoided the bone fracture

Selection of a sample size.

The questionnaire is sent out to a group of volunteers through social media, text messages and emails. There was no age limit or country restrictions for who could fill out the survey. No personal information was collected from the individuals. Responses were collected over two weeks.

Information gathered through the responses to the survey questionnaire is converted into a data set.
The data set from this study is reviewed and cleaned for quality control. The final data set included 303 entries.
Data analysis using Microsoft Excel
Derive conclusions

Procedure 2: By analyzing four data sets from reputable sources

Six data sets from reputable sources related to the topic are selected
Select data that is applicable data for this study
Analysis of the applicable data

Compared the conclusions from Procedure 1 with Procedure 2

Research

Literature Review

What are the Bones in the Human Body?

A total of 206 bones in an adult. At birth, there are 300 bones.
There are five types of bones:

Flat Bones

Protect internal organs like the brain, heart and pelvic organs
Flat like a shield and sometimes has a curve
Attachment for muscles
The flat bones in your skull meet at joints called sutures, sutures can’t move but they will fuse. They don’t completely fuse until your growth is complete, typically around age 20. This allows your brain to grow and expand as an infant and child

Long Bones

Bones that are longer than they are wide like the femur and fingers
Hard and dense bones that can support the body's weight and enable movement

Short Bones

Cube-shaped and contains spongy bones
Found in the wrist and ankle
Allow movement of the wrist and ankle
Intended for strength, compactness, and motion

Irregular Bones

Bones like vertebrae, the middle part of the pelvis (sacrum), and certain bones in the jaw area
Serves various purposes:
- Protect nervous tissue (vertebrae)

Sesamoid Bones (Reinforce tendons)

Is a Bone Fracture Different from a Bone Break?

Bone fracture vs. Bone break

Bone fractures and broken bones mean the same thing and they are used interchangeably. A fracture is simply the medical term for a broken bone

Bone fracture vs. Bone Bruise

A bone bruise occurs when blood is trapped under the surface of the bone due to a forceful impact on the skin's surface and the bone does not crack. A bone fracture occurs when a force breaks or causes a crack in the bone, resulting in a more severe injury and longer healing time.

Bone fractures vs. Sprains

You can’t sprain a bone. A sprain happens when one of your ligaments is stretched or torn. Ligaments are fibrous tissue that connects bone to bone.

The Main Types of Youth Bone Fractures:

Fractures:

Greenstick Fracture

Most broken fractures in children are greenstick fractures, this is because children's bones are more flexible than adult bones
Almost all greenstick fractures happen in children under 10 because kids have softer and less brittle bones than adults.
Greenstick fractures bones that bend so much that they crack but they don't break all the way and they don't break into pieces
They are called greenstick because when you try and break a greenstick (a branch that is still alive, it is still flexible) you won’t be able to break it all the way through
A greenstick fracture happens when there is enough energy to start a fracture but not enough energy to complete it
Treated by immobilizing the fracture using a cast for about six weeks. If the crack is at a bad angle then surgery might be required

Image of cracked tree branch (left) and X-ray of greenstick fracture (right)
Symptoms of greenstick fracture:
- Pain
- Bruising
- Tenderness
- Swelling
- Part of the body looks more bent or twisted than usual
Most common causes for greenstick fracture:
- Fall (especially onto an outstretched hand)
- Sports injuries
- Car accidents
Who is most likely to get greenstick fracture:
- As said before; children under the age of 10. Because they have more flexible bones that are softer and more pliable than adult bones and because children fall more
- Children with vitamin D deficiency
Ways to prevent greenstick fractures:
- Always wear a seatbelt
- Wear proper protective equipment when doing sports (wrist guards)
- Use proper tools (step stools to prevent falling)

Buckle (Torus) Fracture

Torus fracture - Wikipedia — X-ray of buckle (torus) fracture in the radius

Very common in children like the greenstick fracture
Frequently happens around the wrist
When one side of the bone is compressed, the other side bends/buckle
Almost always affects children. They are incomplete fractures meaning the break won't go all the way through the bone
They are compression fractures meaning they are caused by sudden pressure/force to the area (like a fall) that causes the bones to bulge out of place
Like a soda can being crushed
It commonly happens on the ulna and radius, but can also occur on longer bones like; the femur, tibia, fibula, humerus
Most commonly occur when children fall onto outstretched hands and are treated with a split or cast, very very rare for them to be treated with surgery.
They are more common in children than in adults for the same reasons why greenstick fractures are more common in children
It doesn’t happen on small bones like fingers or toes
Very common: 1 in 4 children who break a bone receive buckle fracture and half of all wrist fractures are buckle fractures.
Symptoms of buckle fractures:
- Pain
- Swelling
- Tenderness
- Bruising
- Bump in body that is not usually there
Causes:
- When bones are compressed together with force
- For example; when A child falls onto an outstretched hand
Long bones may bend without breaking the cortex. Children's bones can be bent to 45 degrees before the cortex is disrupted and a greenstick or a complete fracture occurs. However if the bending force is released the bone may only partially return to its pre-bent position, resulting in plastic bowing.

Hairline/Stress fracture

Small cracks in the bone are typically caused over time by overuse. Mostly occurs on weight-bearing bones like leg bones.
Overuse could be: jumping up and down repeatedly, running long distances, sports that involve running and jumping (basketball, gymnastics, dance, track and field, etc.)

What is our natural reflex to a fall?

According to Orthopedic experts, our natural reflex to a fall can be explained using FOOSH.

FOOSH is the shortened term for “fall on an outstretched hand.” It’s one of the most common injuries seen in the Emergency Department and can have a long-term effect on your fingers, hands, wrists, elbows or shoulders. The force of the impact between your hand and the surface you fall on is what creates FOOSH injuries. These can range from bruising to complete fractures.

Tumbles and falls can happen to anyone, at any age. From toddlers to the elderly, from those who are sedentary to professional athletes, our natural reflex to a fall is often to extend our hand.

Data

Procedure 1: Analysis of Data Gathered from My Questionnaire

6.1: Data

This is a screenshot showing the first several lines and the last several lines of the Excel spreadsheet of data gathered from my research questionnaire.

The graph below shows the breakdown of the data.

Procedure 2: Analysis of Data Gathered from Literature

5.1 Data set 1 (Italy Study)

Overview

A study from Italy using data from the outpatient clinic of the Department of Orthopedics and Traumatology of Santobono-Pausilipon Children Hospital in Naples, Italy

Data group: Children from 2 to 14 years old

Study period: 1 January 2008 to 30 June 2008

Number of participants: 382

Applicable Results

Fractures most frequently occurred in homes (41.6%), followed by playgrounds and footpaths (26.2%), sports facilities (18.3%), and educational facilities (13.9%), with gender differences existing only in adolescence.

The lifetime risk of sustaining a fracture in childhood is approximately 42%-64% in boys and 27%-40% in girls. (Average 43.25% between both genders)

Results interpretation

Bone Fracture vs No bone fracture: 43.25% vs 56.75%

Home vs. playground vs. Sport facilities vs education facilities: 41.6% vs 26.2% vs 18.3% vs 13.9 %

Bone broke during sport vs no sport= 41.6+13.9 vs 26.2+18.3

Assumption: Bone broke during sport including playground and sport facility data. Bone broke from no sports including Home and educational facilities.

Excel Screenshot: