Treatment of fractures involves the use of casting, splinting or immobilization of some type. Treatment that is unique to a type of fracture will be described.
Growth Plate Fractures
Growth plate fractures occur directly through the growth plate. If the bone broke in this area but did not move or displace, the X-rays will appear normal. You may ask the physician to "show you" the fracture; however, the X-rays look normal and a fracture line cannot be seen. If your child is tender, has swelling or bruising and a history of an injury to this part, he or she most likely will be placed in a cast or splint for four weeks or more.
Your child may or may not need X-rays once the cast is removed. At this time, signs of healing may be evident, confirming the suspicion of a fracture. It is much better to place your child in a cast / splint for protection than to assume it is "just a sprain."
Closed Treatment of a Distal Fibular Fracture (Ankle)
This fracture occurs on the outside bone of the ankle. The injury may occur when twisting, turning or rolling the ankle. There is pain, swelling and often times bruising around the ankle that may extend to the foot; bearing weight is painful. If the fracture is through the growth plate, X-rays are often normal, unless the fracture is displaced.
Your child is usually placed in a walking cast or boot for about three to four weeks, or until the injury has healed. The patient may bear weight if tolerated, with pain as the guide. An X-ray is usually taken at follow-up, but it is usually normal. Once the cast is removed, the patient may need to limit activity for about two more weeks before returning to sports. Exercise may improve range of motion and strength prior to returning to normal activity.
Closed Treatment of Metatarsal Fractures (Foot)
The metatarsals are the bones in the forefoot just behind the toes. Most fractures are due to one specific acute injury. Stress fractures, although rare in children, can occur from repetitive overuse or stress, such as seen in runners or people taking up new activities that involve being on their feet a lot.
For fractures of the metatarsal, immobilization comes in the form of a cast or wooden sole shoe. These often require four weeks or more to heal. Depending on which metatarsal is broken, your child may need crutches for walking, but most metatarsal fractures are treated with full weight bearing permitted.
Closed Treatment of Tibial Shaft Fractures (Lower Leg)
The tibia is the large shin bone located below the knee. This bone can be broken by an injury that takes significant force, such as in football, or in a toddler by a simple fall. It is one of the slowest bones to heal and can take four to 16 weeks to heal.
If the fracture is displaced, a manipulation is usually done with sedation or pain medication. Your child is then placed in a long leg cast. It is important for the cast to be above the knee to keep the tibia from moving, since it forms part of the knee joint. Usually the patient uses crutches or a wheelchair for the first several weeks and must keep weight off the leg. Once the fracture starts to heal and new bone is present, the patient is allowed to bear weight. Frequently the cast is changed to a below-knee cast, allowing the knee to move and giving the patient more mobility.
If the initial fracture is displaced, X-rays are taken frequently to assure the alignment has been maintained in the cast. Angles can be measured on the X-rays to confirm satisfactory alignment of the fracture. Often the position is not perfect, but future growth will usually correct any offset and give excellent results.
Closed Treatment of Metacarpal Fractures (Hand)
The metacarpals are the bones that form the palm of the hand, located just before the fingers. Most fractures of the metacarpals involve bones that lead to the small finger (fifth finger). These breaks are commonly known as "boxer's fractures," since the most common mechanism of injury is striking someone or something with a closed fist. If significantly displaced, a manipulation may be necessary.
Up to 70 degrees of angulation, or displacement, can be accepted without compromising the function of the hand. The patient needs to be aware that the prominence of the knuckle may be lost after the fracture heals. Casting may be needed for four to six weeks.
Buckle fractures are incomplete fractures that compress (buckle or dent) one side of the bone. These fractures usually occur near the end of the bone. They are among the quickest to heal, and may require only three to four weeks of bracing or casting.
Greenstick fractures involve a complete break on one side of a child's bone, and a bending of bone (stays partially together, or intact), on the other side. This is similar to snapping the branch of a young tree, in which it cracks on one side but it stays partially intact, on the other side. Length of treatment time is dependent upon the location of the fracture.