You’re at the ER when you get the news: The tumble your kid took on their bike or that slip on the sports field left them with a broken bone. There are several ways to treat it, but a lot depends on the type of fracture, how severe it is, and your child’s age.
Splints and Casts
Many broken bones (also called fractures) can be treated with a splint or a cast. They keep the bone from moving, which helps it heal. It also cuts down swelling and pain.
If your child has a minor fracture, a splint may do the trick. It works by supporting their bone on one side to keep it from moving around so it can heal.
Some splints are made of stiff plastic or metal. Others are made from plaster or fiberglass. It’s molded to fit the injured area snugly and comfortably.
If your child’s doctor gives them a splint, they’ll wrap it with cloth, straps, or Velcro. This locks it into place. They may make adjustments as it heals.
If your child has a lot of swelling, their doctor may start with a splint, which is gentler and looser than a cast. When the swelling goes down, they’ll remove it and put on a cast.
If you are at an urgent care, the doctor may put on a splint until your child can be seen by a specialist. This is typically an orthopedist.
Most fractures need one. It surrounds the entire area that’s broken, so it’s stronger and better at protecting it than a splint.
Casts have two parts: A soft, inner layer that cushions the skin and a hard, outer layer that keeps the bone from moving.
There are two types:
Plaster of paris. If your child needs a strong hold, they may have a cast made from this. It’s a thick paste that hardens quickly.
The upside is it’s strong. The downside is that it’s heavy and doesn’t do well in water.
Synthetic or fiberglass. These casts are made from a moldable plastic. They’re lighter than plaster of paris. The outer layer is fairly water-resistant, and some have a waterproof lining.
Sometimes the pieces of your child’s broken bone aren’t lined up right. You may hear their doctor call this a “displaced fracture."
In that case, the doctor will manipulate the bone pieces back into place. It’s a nonsurgical procedure called a “closed reduction."
Lining up the pieces helps the bone grow back together in a straight position.
After it’s over, your child’s doctor will do an X-ray to make sure it’s lined up right. Then they’ll put on a cast. That keeps the bone fragments in the right position as they heal.
If the break is too complicated for a closed reduction, your child’s doctor may do a surgical procedure called an “open reduction." They’ll make a cut in their skin and attach metal pins or plates to the bone fragments. This keeps them in place as they heal.
Your child’s doctor may recommend an over-the-counter pain medicine such as acetaminophen (Tylenol) or ibuprofen for the first few days, or a prescription drug. They may also prescribe antibiotics to fight infection, especially if surgery was needed.
The Healing Process
Kids’ bones are softer than those of grown-ups, so they often heal in less time than it takes adults. Young children often have a speedier recovery than teens.
You can expect your child to have a cast for about 4-8 weeks, although it’s sometimes as short as 3 weeks.
Even after your child’s cast is removed, their bone will keep healing. At first, it will have a thick layer of new bone surrounding the area. This is called a callus and it feels like a knot or bump. It will gradually get smaller.
Taking Off the Cast
When your child’s broken bone is healed, your doctor will remove their cast.
First they’ll examine the area to make sure everything’s OK. Then they’ll use a special tool to take off the cast. It’s like a saw but it has a dull blade that moves from side to side. It makes vibrations, which break the cast apart.
When it’s off, they’ll look at the injured area, check for pain, and see if your child has a good range of motion. The doctor may order a follow-up X-ray to make sure the bone has healed.
Your child’s skin may be dry, flaky, or pale at first. They may have thicker, darker hair where the cast was. You may notice a funny smell. Their muscles may be smaller and weaker. Don’t worry. In time, it will get back to normal.
Your child may need to hold off on certain activities after their cast is removed. Their doctor will tell you what’s OK and when they can get back to the fun things they love to do.
Referenced on 22/05/2021
- American Academy of Pediatrics: “Children And Broken Bones."
- American Society for Surgery of the Hand: “Fractures in Children."
- Boston Children’s Hospital: “Treatments for Fractures in Children."
- Massachusetts General Hospital: “Fractures: General Information."
- The Nemours Foundation: “What to Expect When Your Cast Comes Off."
- UCSF Benioff Children’s Hospital: “Care after Cast Removal."