Most fractures in children can be satisfactorily treated in a plaster cast. The fracture is often first placed in a splint before the plaster is applied. The splint will allow for swelling, which may occur in the first few days following the injury. When the swelling goes down, a carefully shaped plaster cast is placed to hold the bones in the correct position (in alignment) and immobilised until the fracture is healed.
If your child has a displaced fracture (the bone ends are no longer in line), they may need to have the bones moved (manipulated) into a better position before a plaster cast is applied. This usually requires a general anaesthetic or sedation.
Sometimes an operation is required where metalware (such as screws, nails, plates and/or wires) is used to keep the bone in the correct position. This surgery is called an ORIF (open reduction and internal fixation) and is done under general anaesthetic. Types of fractures that may require this type of surgery are:
- fractures extending into a joint (articular fracture)
- fractures displacing a growth plate (the cartilage or connective tissue at the ends of long bones in growing children) (epiphyseal fracture)
- fractures through abnormal bone (pathologic fractures)
- fractures where the bones are significantly displaced and can’t be lined up (reduced) or won’t stay lined up after manipulation
- fractures exposed by broken skin (open fractures)
Sometimes, traction may be used. This involves the use of pulleys, weights and bed rest. It is usually a short term measure to maintain the position of the bone.
Your doctor/orthopaedic surgeon (a doctor who specialises in conditions related to bones, ligaments, tendons and muscles) will discuss with you what treatment is necessary for your child’s fracture.
Will my child have to stay in hospital?
The time your child is in hospital will depend on:
Most simple fractures can be treated in the emergency department and your child will be able to go home from there.
If the fracture is more severe, the medical team will keep your child in hospital to watch the swelling, raise (elevate) the limb and give stronger pain relief if needed.
How long will it take for the fracture to heal?
Each child will heal differently – some more quickly or slowly than others. The length of time taken for healing depends on where the fracture is and how severe the break is. For example, a simple buckle fracture will need a plaster cast for 2 to 3 weeks and be almost completely healed in 4 weeks. Children heal in about half the time it takes an adult to heal from a similar injury. Often fractures in bones that are growing will correct their own shape (‘remodel’). This means that some degree of incorrect positioning or displacement in the fractured bones of children is all right as they will correct themselves with time.
Little girl injured with broken ankle.
How can I care for my child at home?
In the first few days, your child may have swelling and discomfort in their fractured limb. To reduce the swelling and discomfort when your child is resting, raise the limb by resting it on a pillow.
If your child has a fractured arm, they should wear an arm sling when walking or when they are up and about.
If your child has a fractured leg, they will need crutches. Follow the instructions of the medical team about when your child can put weight (stand or walk) on their leg. Remember that in the first few days rest and elevation of the affected leg is necessary and crutches should only be used for short periods such as getting up to go to the toilet.
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