To accompany our kids’ book, “Broken Bones and Broken Hearts,” we sat down with Dr. Jason Jagodzinski, Pediatric Orthopedic Surgeon and professor at UC San Francisco’s Department of Orthopedic Surgery. He’s also dad to three kiddos, one of whom broke a bone during the writing of this book! Below, he answers some of the most common questions he’s asked by parents and caretakers when their child comes in with a broken bone.
So is it broken or fractured?
While this is a common question, there is no difference between a break or fracture. Some think it might be more or less severe, but anytime a bone is injured and is no longer in one piece, it is considered a fracture. People can call it broken, cracked, fractured, or otherwise, but all effectively mean the same thing.
There are some injuries that are more severe such as open fractures that come through the skin, comminuted fractures (which are broken into more than two fragments), or fractures associated with nerve or blood vessel damage.
When will my kid be better?
All fractures heal at different rates, but typical bone healing ranges from 4 to 8 weeks. Factors that affect bone healing include age, other injuries, and general nutrition—especially your calcium and vitamin D levels.
Bone healing happens in a fairly standard manner. In the first phase of healing, the bone bleeds and creates a localized blood clot. This blood clot then turns into cartilage over the course of the first couple of weeks. The cartilage is called soft callus. In time, if the fracture stays immobilized, the soft callus converts to bone and becomes hard callus. This is what you see on x-ray after about 2 weeks. This hard callus needs to become stronger before immobilization is removed. This usually happens by 4 to 6 weeks.
Most injuries are treated like this, however, some require surgery which may change the timeline of recovery. It is always best to communicate with your child’s healthcare provider to be sure bone healing is happening appropriately and that your child is not returning to activities too soon.
What should I watch out for when my kid is in a cast?
The most important part of cast care is keeping it clean and dry. Some casts may be waterproof, but most are not. The padding that is used most of the time can become waterlogged and create bad skin problems if the cast gets wet and is not changed promptly. If this occurs, your child could develop a skin infection, or if pins or a surgical incision were needed to heal the fracture, these could also become infected.
Another common problem with casts is itchiness. It may be tempting to put something into the cast to scratch your skin, but this is risky, because if the skin gets cut you cannot clean it like you normally would. This again puts you at risk for getting an infection.
Some tips you can try for itching under the cast:
- blow cool air with a hair dryer into the cast to dry out your skin,
- tap on the outside of the cast where your itch is,
- try scratching your other limb in that same location,
- sometimes over-the-counter antihistamine medication, like Benadryl, can help
Is there anything I should be prepared for when the cast comes off?
The cast removal process can be stressful. Most casts are removed with a cast saw. This is usually an oscillating blade that cuts hard material (like the cast) but does not cut soft material (like the cast padd
ing or your skin). These machines are usually connected to a vacuum cleaner to suck away the dust. This can be very scary to a child, and the most important thing to remember is that these saws are designed to not cut the person. Most cast technicians who remove the casts can show you how this is safe. Being prepared for this is the most important step in making cast removal successful.
Once the cast is off, you will find there may be some discomfort because your arm or leg has not moved for quite some time. Plus, your skin may look really scaly with dried skin. While tempting, do not scratch it really hard or try to get all of that skin off just yet. It will fall off in time, but you do not want to scratch your skin too hard and get scrapes. That’ll be worse! Start by just washing it with a gentle soap and washcloth.
Finally, one interesting thing that happens often, is that your hair on your arm or leg might look darker and coarser than the hairs on the other limb. I have not figured out why this happens, but it is an interesting thing to see. This gets better in time, as well.
One thing to think about and remember before you get your cast removed, is to have some over-the-counter pain medications available, just in case you are feeling uncomfortable on the ride home from the office visit.
After the cast comes off, how long before my kid is back to normal?
Again, all injuries are a little different, so talk to your healthcare provider first. In general though, after your cast is removed, you still need to work through the stiffness of your joints from being in a cast, the
weakness of your muscles that weren’t able to exercise when you were in the cast, and the final strengthening of the bone before you get back to your activities.
Most of the time, this occurs over the course of the first month after your cast has been removed. To be safe though, talk to your doctor first before you do things that could cause a fall or a new injury to occur.
Will this affect their growth?
This is a very common fear to have with a broken bone in a child. Some fractures do occur at the spot where the bone grows. This is the location called the growth plate, or physis. Since the growth plate can be a weak spot in the bone, it sometimes is where the fracture happens. Some of the growth plates in the body are more resilient than others, and some fracture patterns are more likely to affect growth than others.
Because of this variability, this is an important question to talk to your healthcare provider with. If the growth plate was not involved with the fracture, usually normal growth is not affected.