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BROKEN BONES AND FRACTURES

At Medical City Children’s Orthopedic and Spine Specialists, it’s important that your child sees a pediatric orthopedic physician who specializes in children and understands a child’s growth plates when casting or performing surgery on growing broken bones.

If you suspect your child has a broken bone, it’s important to see a pediatric orthopedic physician
right away to assess the timing of the diagnosis and treatment.

Broken Bones and Fractures

A child in a wheelchair with broken legDid you know the terms “fracture” and “break” mean the same thing? A fracture means a break in any bone in the body, and there are many different types of fractures. If you suspect your child has a fractured or broken bone, it is important to see a pediatric orthopedic physician as soon as possible after the injury. It’s not a good idea to wait until the child grows to correct the fracture as a small surgery might turn into a big one.

We often see patients who have broken bones participating in the following activities, so exercise additional caution when letting kids participate in these activities:

  • Playing on monkey bars is the number one way kids break bones
  • Jumping on trampolines is number two!
  • Contact sports like football and gymnastics/competitive cheer
  • Riding ATVs/dirt bikes
  • Jumping in bounce houses
  • Riding down slides in a parent’s lap

Common Ways Children Fracture Bones Playing Sports

It’s no surprise that sports injuries are among the most common pediatric orthopedic injuries. But how do those accidents most often happen?
  • Collisions
  • Pileups
  • Twisting
  • Falling

How do I know if my child has a broken bone?

“If you feel your child may have a broken bone, be sure to bring him or her to Medical City Children’s Orthopedic and Spine Specialists so one of our pediatric orthopedic specialists can provide a comprehensive diagnosis. It’s often hard to diagnose a broken bone without an X-ray exam and a medical exam.” Shyam Kishan, MD. “That’s why we have an X-ray located in our office. When you arrive at our office, we will X-ray your child’s possible fracture before you see that physician. That way, you will know if your child has a broken bone and what the plan of treatment is before you leave the office.”

Symptoms of a Broken Bone

Children who exhibit any of the following symptoms may indicate a broken bone or fracture and should be seen right away:
  • Intense pain or pain that lasts longer than a few days after a fall or injury
  • Swelling, bruising or bleeding
  • Numbness and tingling
  • Not using or favoring an arm or leg
  • Unable to walk or walking is crooked
  • A child who can’t talk keeps pointing to a body part or cries when it is moved or touched
Here are some ways to lower a child’s risk for broken bones and other injuries. Make sure your child:
  • Gets plenty of sleep, eats a balanced diet, and stays hydrated
  • Wears protective gear appropriate for their sport or activity
  • Warms up and stretches muscles and joints before activities
  • Plays in areas that are safe and free of holes, ruts, and debris
Protect your little athlete by making sure he or she knows how to play the game, is properly supervised by qualified adults who know CPR, and is outfitted with the proper equipment and safety gear.

Common Pediatric Fractures Include

Buckle Fractures

Treating children’s broken bones is our specialty and expert patient care is our focus. A bone can fracture in several different ways. For example, a buckle fracture is the most common fracture in the arms and feet of young children. This form of fracture is ‘incomplete’, which means that the bone does not break completely; instead, the bone bends and has a small crack in it. Another type is a complete break of the bone that does not damage surrounding tissue or tear through the skin.  This is known as a closed (or simple) fracture. A break that damages the surrounding skin and penetrates the skin is known as a compound fracture or an open fracture. Compound fractures are generally more serious than closed fractures because they can get infected.

Most human bones are surprisingly strong and can generally stand up to strong impacts or forces. However, if that force is too powerful, or there is something wrong with the bone, it can fracture. Because children’s bones are more elastic, when they do have fractures, they tend to be different. Children also have growth plates – areas of growing bone – at the end of their bones which may sometimes be damaged. Therefore, it is important for children to see an orthopedic surgeon who is also a pediatric physician when they experience a fractured bone.

Ankle Injuries

Ankle injuries are common complaints in both emergency rooms and family physicians’ offices. They are serious and require immediate attention from a qualified and highly skilled pediatric orthopedic doctor.   Approximately 1 million ankle injuries occur annually in the United States. Treatment options differ according to the grade of injury.  Grade I and grade II sprains usually respond to rest and immobilization, while grade III sprains require casting or, possibly, surgery.

Ankle fractures are more severe than ankle sprains and require immediate treatment. When there’s a complete or partial break due to trauma, the child will not be able to put any weight on the ankle. Parents will see swelling, bruising and severe pain.  An ankle fracture can be caused by harsh accidental movements, such as twisting of the ankle in everyday sport or activity. Car accidents can also cause ankle fractures, especially high-impact ones. Tripping, falling, rolling your ankle, or rotating it the wrong way can create an ankle fracture.

Arm Injuries

When a child breaks an arm, the doctor will first carefully examine the injured area for tenderness, redness, and swelling. Then the doctor will have an X-ray, MRI, or CT scan taken so that the arm can be observed and checked for damage to the bone, muscles, or blood vessels:

Our expert pediatric orthopedists treat broken arms depending on the specific location and degree (severity) of the break and your child’s age, overall health, and medical history. Our physicians will determine your child’s treatment plan and follow-up based on their physical examination and other tests.

Broken Collarbone

A broken collarbone, which is also referred to as a broken clavicle, is a common injury, particularly in children and teenagers. The collarbone connects the upper part of your breastbone with your shoulder blade. The most common causes of a broken collarbone in children include falls and sports injuries. Infants can sometimes break their collarbones during the birth process.

Parents should promptly seek medical attention for a broken collarbone. Most patients heal well with ice, pain relievers, a sling, physical therapy and time. But a complicated break might require surgery to realign the broken bone and to implant plates, screws or rods into the bone to hold the bone in place during healing.

Upon examination, our doctors will ask about your child’s injury and symptoms. The doctor will also examine your child’s shoulder and may press gently on the collarbone. Our Specialist may also check the feeling and strength in your child’s arm, hand, and fingers. An x-ray or CT scan will clearly identify the fracture. Your child may be given a contrast liquid to help a collarbone fracture show up better in the pictures. Tell the healthcare provider if your child has ever had an allergic reaction to a contrast liquid.  Upon an official diagnosis, the doctor will discuss an individualized treatment plan with the parents.

Elbow Injuries

The elbow is a joint that connects the humerus bone of the upper arm with the radius and ulna bones of the lower arm through a complex network of muscles, ligaments, and tendons. The elbow is much more than a simple hinge, the unique arrangement of the elbow allows for rotation.

Treatment of injuries and diseases requires specialized knowledge. Our physicians are recognized as leaders in the diagnosis and treatment of elbow problems. They provide an extraordinary base of shared knowledge with leading-edge kids surgery and treatment.

Hand Injuries

The hand consists of dozens of bones, joints, ligaments, tendons, and muscles that need to work together seamlessly in a variety of positions hundreds of times a day. As such, hands often require highly specialized medical care when they become injured.

Hip Injuries

The following are just a few of the problems that we treat relating to the hips.

  • Hip Bursitis
  • Contusions (Hip Pointer)
  • Stress Fractures
  • Hip Labral Tear
  • Femoroacetabular Impingement
  • Osteitis Pubis
  • Snapping Hip Syndrome
  • Traumatic Hip Subluxation & Dislocation

As with all Hip Injuries, the treatment and care of children must be provided by the most highly skilled doctor who knows about growth plates and specializes in Children. 

Knee Injuries

Our compassionate team of medical professionals will sit down with you and your child to perform a detailed physical examination to determine your child’s diagnosis. Your physician will often order an x-ray exam. After careful interpretation of your X-ray and your physical exam, your physician will discuss a treatment plan with you and your child. If your child needs surgery or casting, we can schedule you for that day or the very next morning. There’s no sitting in waiting rooms. We make sure you are seen right away.

Cast Care Instructions

What is a Cast?

Casts are custom-made protective devices used to keep broken bones from moving after an injury.  They can also decrease pain and muscle spasms during the healing process.   The cast applied today is made out of fiberglass and is waterproof.

Please wait 4-5 hours before getting the cast wet.  This allows for the fiberglass on top to set. The waterproof casting material is special because it helps pull water away from the skin. After getting wet it takes approximately 1 hour to dry.

Sometimes casts are used to treat conditions other than broken bones, such as severe sprains, growth plate injuries, and overly tight muscles.

Care:

Elevate the injured arm or leg on a pillow for the first 24-48 hours after injury or surgery. If an arm or leg is too swollen at the time of cast placement, your doctor may partially open/split the cast on one or both of the sides to prevent the cast from becoming too tight, and to allow for swelling.

  • Keep the cast clean and dry
  • Itching: Some itching is normal when wearing a cast and is best treated by blowing a hairdryer on COOL setting only down either end of the cast. Do not stick anything in the cast to scratch or itch.
  • If you were given a sling, you must wear this when you are upright until otherwise specified by your physician

Cautionary Measures

  • Do not put anything in the cast (hangers, pencils, money, etc.)
  • Do not try using a plastic bag or immerse cast in water
  • No powders, ointments, or lotions in or around the cast
  • Do not trim or cut cast
  • Avoid dirt or sand in cast

Warning signs:

If your child experiences any of these symptoms or you have other concerns, call your doctor’s office immediately for instructions:

  • Increasing pain or the child complaining that the cast is too tight
  • Numbness or tingling in the fingers or toes
  • Excessive swelling at the ends of the cast
  • Inability to move the fingers or toes
  • Fever greater than 101 degrees
  • Foul odor or drainage from the cast

Care:

  • It is ok to go swimming and take a bath
  • Shake/Drain the water out of the cast by holding the hand/foot down towards the floor and lifting the hand/foot up towards the sky
  • Avoid getting anything in or down the cast
    • This includes sand, lake debris, lotions, powders, toys, etc.
    • The skin can become irritated, itchy, and cause breakdown or sores
  • Do NOT stick anything in the cast to scratch your skin
    • If your skin gets scratched it can cause skin infection leading to worse problems
    • It is ok if soap gets in the cast just be sure to rinse thoroughly with clean water

Itching:

When a cast is in place, there may be some itching under it.

Recommendations to help with the itching include:

  • A hairdryer on a COOL setting
  • Benadryl by mouth over the counter (recommended dosage as noted on the packaging)
  • Tapping on the cast

Cast Removal:

The cast will be removed in the doctor’s office with a special tool called a cast saw.  This special saw vibrates but does not rotate, so the skin underneath the cast is not injured during cast removal.  The noise of the cast saw sometimes bothers children, but removing the cast will not hurt.  Cast removal is easiest with a dry cast, please do not wet the cast 8-12 hours prior to your appointment.

“If your child suffers from a broken or fractured bone, rest assured that the pediatric orthopedic specialists at Medical City Children’s Orthopedic and Spine Specialists specialize in the treatment of broken and fractured bones children.” Kathryn Wiesman, M.D.

Call 214-556-0590 to make an appointment.

Comprehensive services for children from birth through adolescence at four convenient locations:
Orthopedic Specialists in Dallas, Arlington, Frisco, and McKinney.