Fracture and Cast

Key points to remember

a fracture is a break in the bone
there are different types and names of fractures
the type of fracture will determine what treatment is needed
each child is different and some may heal more quickly or more slowly than others
the length of time taken for healing depends on where the fracture is and how severe the break is
after initial treatment, you should take your child back to the accident and emergency department urgently if:
- they complain of worsening pain that is not helped by pain relief and elevation (raising the fractured limb)
- their hand/foot goes cold or blue
- they complain of fuzziness, numbness or tingling in the fractured limb
make sure your child goes to all follow up appointments with your doctor; often further x-rays are taken to check healing and bone position
your doctor will advise when your child should return to normal activities

What is a fracture?

A fracture is a break in the bone. There are many different types and names of fractures; for example:

closed fracture: the bone is broken without damage to the skin or outer tissues
open or compound fracture: the skin is injured at the site of the fracture, giving direct access for germs to enter the bone (this can lead to bone infections)
greenstick fracture or buckle fracture: a common injury in children because a child's bone can bend or buckle more easily than an adult's, without completely breaking

How is it diagnosed?

An x-ray is used to diagnose the type of fracture and whether or not the bones are in line (whether there is displacement).

What is the treatment?

First aid:

keep the injured limb still or immobilised (using a device such as a splint); support the injured limb with a pillow or sling
raise the limb higher than the heart to help reduce swelling
pain relief may be needed (paracetamol may help reduce the pain. You must follow the dosage instructions on the bottle. It is dangerous to give more than the recommended dose)

Fracture treatment

There are a variety of different treatments for helping heal broken bones.

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:

the bone(s) involved
the type of fracture
the treatment required
the pain relief required
how much swelling your child experiences

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.

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.

See what signs to watch out for in 'When should I seek help?' below.

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.

Pain relief is usually required for the first few days after discharge. Your nurse or doctor will discuss your child's individual needs with you before you leave hospital.

After going home it is important that your child is careful. They should return to normal activities (such as school and sport) on the advice of your doctor.

When should I seek help?

After being sent home, you should take your child back to the accident and emergency department or contact your medical team urgently if:

they complain of pain that is worsening and not helped by pain relief and elevation (raising the fractured limb)
their hand/foot goes cold, pale or blue (or becomes increasingly swollen)
they complain of fuzziness, numbness, pins and needles or tingling in the fractured limb or in the toes or fingers of that limb
they are unable to move their toes or fingers

If the plaster becomes cracked, broken, soft or loose, or it is rubbing, don’t walk on it (if it is a leg plaster) – use crutches and contact your medical team. If this happens in the evening, contact your medical team the next morning.

What follow up is required?

It is very important that your child returns for their follow up appointments.

Your child will usually be given a fracture clinic appointment 5 to 14 days after discharge. At this appointment, another x-ray will be taken to make sure the bone is healing and is in place. Follow up at fracture clinic will usually be required several more times after this to ensure the break is healing.

Make sure you are given individual instructions for follow up from your nurse or doctor before you leave hospital.

Credits & Documentation references

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