Fractures between the shoulder and the fingers are common in school aged children. Statistics are hard to pin down, but Thierry Benaroch, a paediatric orthopedic surgeon at Montreal Children’s Hospital and the Shriners Hospitals for Children, reports that about 20 percent of the visits to his emergency room are kids coming in with bone fractures. While older kids may injure a leg in contact sports, young children often get breaks in their arms, elbows and wrists, usually because they’ve braced themselves after a tumble.
Look for the signs
While certain breaks are obvious, some kids will snap their arm or fracture a foot and continue on with their day as if nothing is wrong. Look for swelling and bruising — which will appear right away after a break — or give the area a firm touch. If you get a yelp, it’s probably broken, says Benaroch.
After a diagnosis by X-ray, doctors will manually set the bone. Children will often receive a sedative, which almost knocks them out, so they’re unaware of the pain. In five to 10 percent of fractures, a child will need surgery — if the break involves the joint, and the doctor can’t set it manually, or if an X-ray reveals damage to the growth plate at the end of a bone.
Depending on the location and type of break, most kids will get a heavy white cast — the classic plaster kind that cannot get wet. (Look for special cast covers at a medical supply store, or improvise and use a plastic bag.) You can expect the cast to get stinky and itchy, but Benaroch says to never put anything in the cast to scratch, as you can cut the skin and trigger an infection. “Distraction is the best solution,” he advises.
After four weeks, the white plaster cast is usually replaced with a lighter fibreglass cast that comes in a rainbow of colours (and even camouflage print). Some fibreglass casts have a waterproof lining, which allows kids to bathe normally.
Typically, the doctor will remove the fibreglass cast after about two weeks. Don’t be surprised if your child’s limb is skinny, weak and hairier than it was before (the heat trapped inside a cast increases hair growth).
Kids may need to take it easy for six weeks after the cast comes off. “I always say it takes as long to get their strength back as they’ve been in the cast,” says Benaroch. Most patients need one follow-up to make sure they’ve regained their range of motion (if growth plates were involved, a doctor may monitor a kid’s growth into his teen years.) Otherwise, life returns to its rough-and-tumble normal.
A version of this article appeared in our September 2012 issue with the headline “Bad break,” p. 88.
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