Fracture! The Right Treatment is Vital

Big Apple Parent—May 27, 2008

by Daniel W. Green, MD; David M. Scher, MD;
Roger F. Widmann, MD

With the number of pediatric orthopedists trained to deal with the special bone, joint and tendon problems of children dwindling, more hospitals rely on general orthopedists to evaluate and treat pediatric injuries, such as fractures. Parents need to be aware of how to get the right treatment for their child's injury in order to have the best outcome in the long run.

Daniella, 5, jumped off her brother's bunk bed — and broke her elbow. Daniella's parents took her to their local emergency room. When the doctors removed her cast eight weeks later, her parents quickly realized that her arm may not have set properly.

To help their daughter, the family found the Pediatric Orthopedic Surgery Service at Hospital for Special Surgery on the Upper East Side. Since then, Daniella's elbow has been re-set and, with physical therapy cast removal, she is healing well.

Daniella's parents' experience isn't necessarily uncommon. The numbers of orthopedic residents choosing pediatrics as a subspecialty is not keeping up with demand in some areas. And advances in medicine have made it difficult for general orthopedists to stay abreast of the best treatments for children in the same way that a sub-specialist can.

How can parents help prevent pediatric fractures?

Proper supervision can help reduce falls that often contribute to fractures. Also, always make sure your child is wearing appropriate protective gear, like wrist guards during activities like rollerblading, and helmets while skateboarding, bicycle riding and other outdoor activities. Beware that fatigue and weakness can lead to a stumble or fall that can result in a fracture.

What are the signs that your child may be suffering from a fracture?

• Refusal to use or bear weight on a limb: Kids will tell you that they're in pain. But, in a child who is not old enough to identify where he hurts, refusal to bear weight on a leg or use a limb could indicate a fracture. In some cases of a leg or lower extremity fracture, the child may be able to walk, but may do so with a limp. If it's an upper extremity fracture, she will likely fold her arm and refrain from using it.
• Mild swelling: Even with a minor fracture, the child might still use the injured limb and you may notice some mild swelling.

What should you do if your child has a fracture?

• Comfort: The first step is to try and keep the child as comfortable as possible until you can see a doctor. If it's a serious fracture, you should seek out immediate medical attention.
• Ice and Elevation: Putting ice on the extremity and elevating it above the heart can make a difference in the degree of swelling. Icing can also affect a pediatric orthopedic surgeon's ability to operate (if need be) and can help avoid problems with wound healing.
• Splinting: Getting some type of rigid splint on an injured extremity is often the most effective way to initially control a child's pain. Until the child is seen by a medical professional, a makeshift splint with materials such as cardboard may be helpful. Just be careful that nothing is wrapped tightly around the limb. Anything used to secure the splint should be wrapped as loosely as possible.
• Stay Calm: Remaining calm for your child's sake is essential. If you remain level-headed, it will reassure your child.

How can you get the right treatment for your child's fracture?

• The Right Facility: If you suspect your child has a fracture, you should seek out medical attention at a facility that has specialized pediatric care.
• Pediatric Orthopedic Surgeons: These surgeons have been specially trained in the most effective techniques to treat your child and are the best qualified medical professionals to manage pediatric fractures.
• Urgent Care Service: Look for an urgent care service that can provide around-the-clock access to pediatric experts who can help coordinate your child's care when a fracture occurs.

Getting the proper treatment from the start can speed up the health and recovery process, and help make sure that the fracture heals in the right position — which will help avoid future complications, functional limitations and need for additional treatment.

Doctors Green, Scher, and Widmann are pediatric orthopedic surgeons at New York City's Hospital for Special Surgery. To access HSS's  Pediatric Orthopedic Urgent Care Service around-the-clock, call toll free 1.877.HSS-1KID (1.877.477.1543).

Read the full story at nymetroparents.com.