It’s a scary experience when your child breaks a bone. The most common fracture I see in children is a broken arm, either at the wrist or in the elbow. It’s normal for parents to have lots of questions when they come in the office. These are some of the most frequently asked questions I get about pediatric fractures.

 

What is the difference between a fracture and a break?

These words mean the same thing to a bone specialist. Even if the bone is just cracked, it’s still called a broken bone. The more technical term is a fracture, but both words mean the same thing.

There are many different kinds of fractures; some are worse than others. If the broken bone is just cracked or bent, it will heal on its own without any surgery or procedures. These breaks can be treated in a cast or splint.

Normal healing and function of bones depends on whether the pieces are lined up normally with each other and with the rest of the body. The purpose of surgery is to move the pieces where they need to be to let them heal correctly. Sometimes metal pins are used to hold the bones in place; in other situations, no pins are necessary.

Is it in the growth plate?

One of the more serious types of fracture is a growth plate fracture. This is where the bone breaks right next to the joint, where the bone is growing. Depending on where the line of the fracture goes, surgery may be necessary to get the bone to heal the right way.

The growth plate is just a collection of special cells at the ends of bones where new bone growth takes place. If this part of the bone is injured, the bone may not grow correctly, creating problems months or years after the injury.

Growth plate injuries are sometimes difficult to diagnose. The growth plate looks like a dark line on the x-ray – sometimes it’s confused with a fracture. Just because it’s not moved out of place doesn’t mean it shouldn’t be treated like other fractures, and they usually need a cast.

Is surgery necessary?

Surgery for broken bones is recommended when the pieces of the fractured bone are not lined up in the right way. Obviously if the bone came through the skin (called an open or compound fracture), surgery is required to clean the bone and line up the fractured pieces of bone.

Even if a child’s bone doesn’t line up perfectly, the bone will heal and straighten out over time in most situations. The younger the child, the more straightening happens as the break heals. Another way of saying this is that the older a child is, the higher the chances he’ll need surgery to fix a badly broken and deformed bone.

When will the bone heal? Will it heal faster with surgery?

A child’s bone heals slightly faster than an adult’s, though healing is usually complete after six weeks. A healed bone does not hurt when you push on it, and x-rays are usually necessary to tell if the bone is lined up and healing well.

Surgery does not speed up the healing process; it just lets the surgeon line up the bones in a more perfect way so that the body can heal the break on its own. The healing process still takes about six weeks once the surgeon lines up the bones in the operating room.

Sometimes pins or screws are used to hold the bone in place while it heals. These can be taken out later or left in place forever. Each fracture situation is a little different. If the pins or screws won’t cause a problem with growth or irritate the skin, they’re usually left in. Be sure to ask this question during any discussion of surgery in the office.

Do you have waterproof casts?

There are two parts to a cast: the cast padding, or liner, and the hard outer shell (usually made of fiberglass or plaster). Waterproof casts are made with a water-resistant liner that rests up against the skin and dries out faster than regular cotton-like cast padding.

Water-resistant cast liners are usually more expensive than regular padding, but our patients and parents have had good results so far with this option. Be sure to ask about this before any cast is applied.

I’m sure you’ll have more questions when you come into the office – write them down ahead of time so you won’t forget to ask!

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