Fracture/Bone Healing

Broken (fractured) bones heal quite quickly in children, so they are usually only put into a cast for 4-6 weeks. By this time, the bone has had time to lay down a thick layer of new bone called ‘callus’ around the fracture to hold it in place. The cast will also reduce pain, swelling and muscle spasms. After the cast is removed, you may be able to see and/or feel a hard ‘knot’ or ‘bump’ at the callus. Over the following several months, the bone continues to heal, removing the rough edges, remaking the hard outer covering and the marrow inside, and removing the extra layers of callus. During ‘remodeling’, the body can straighten the fracture by laying new bone on the inside edge, and taking away bone on the outside of the angled area. In young children, bones can remodel fairly large angles, healing to appear completely normal within one to two years.

Cast Care

Caring for your new cast is very important. You must keep it dry, and watch for signs that the cast is becoming too tight (from swelling) or too loose.

You may be instructed to elevate the cast to the level of the heart for the first 3 days to keep the swelling down. You will have to keep the child reclined to elevate a leg cast. Every hour, while awake, the child should try to gently move uninjured fingers or toes. This will also keep the swelling down and encourage circulation. Ice (in a sealed plastic bag) can be applied on or next to the cast. This will help with pain and swelling.

If the cast becomes too tight, despite elevation and ice, you must call the Orthopaedic office immediately to get advice [(510) 428-3238, ask for a nurse during the day or follow directions to speak to the doctor on call at night and on weekends].

Signs that the cast is too tight are:

1. Increased pain, throbbing inside the cast.
2. Numbness, tingling or “pins and needles” feeling in fingers/toes.
3. Skin under the cast feels like it is burning or stinging.
4. Poor color of fingers/toes (pressed gently, nail beds should pink up within 3 seconds)
5. Unable to move fingers/toes at all.

Keep your cast clean and dry!

1. No showers. Sponge baths are best. Supervised shallow water tub baths are OK with short arm or leg casts. Seal the cast in plastic bags, then hold it out of the tub.
2. Keep dirt, sand and powders away from the cast.
3. Do not allow the child to pull the padding out of the cast.
4. Do not stick anything in the cast. Nothing at all.
5. Wrap walking casts in plastic bags if it is raining. Avoid puddles.
6. Always wear a cast shoe for walking casts.
7. Do not allow walking in a long-leg or spica cast.
   

Broken (fractured) bones heal quite quickly in children, so they are usually only put into a cast for 4-6 weeks. By this time, the bone has had time to lay down a thick layer of new bone called ‘callus’ around the fracture to hold it in place. You may be able to see and/or feel this hard ‘knot’ or ‘bump’ at the callus. Over the next several months, the bone continues to heal, removing the rough edges, remaking the hard outer covering and the marrow inside, and removing the extra layers of callus. During this ‘remodeling’, the body can straighten the fractured bone by laying new bone on the inside edge, and taking away bone on the outside of the angled area. In young children, bones can remodel fairly large angles, healing to appear completely normal within one to two years.

After the cast is removed it is normal for there to be some discomfort in the bones and joints that were immobilized, for the arm or leg to be smaller than the other side, and for the skin to have some changes (dry skin and more hair).

A few baths in warm water will soak off the dry, flaky skin. This may take a few days, but be patient and avoid scrubbing the skin. You may apply some lotion to soften the skin if desired. The hair will return to normal in a few months.

The casted area may be tender for a few weeks. The child should avoid jumping, climbing, running or activities with a high risk of falling for at least 2 weeks. This includes sports. It is common for children to limp for a few weeks after a leg cast is removed (up to a year for a thigh/femur fracture). The child may limp with or without pain. If the limping becomes worse, not better over the first 2 weeks, or if the pain persists, you should return to be rechecked.

Most children do not need physical therapy to walk or move normally again. Routine activities and play is usually enough for children to return to normal within a few months. Following a joint fracture it may be helpful to try gentle exercises twice a day. You can have the child move the healing extremity through all of its motions, using the other arm or leg to judge what normal is. Children who do not regain normal motion after a month or two should be rechecked.

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