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What to look out for if you think your child may have broken a bone

What to look out for if you think your child may have broken a bone

Sunday, October 9, 2016 - 15:14

The arrival of summer is accompanied by extended day light hours, which means that children tend to play outside longer and harder. Alas this also means that they are prone to more accidents.

Before I decided to change career direction into general practice, I spent a great deal of my training in the Trauma and Orthopaedic department of Worthing Hospital. This is a department which specialises in dealing with broken bones. Every year, the summer would come and with out fail, the department would become heavily inundated with paediatric admissions all of which were related to some sort of out door activity.

The scenario is often very familiar; guilt-stricken mum and dad come into A & E with little Johnny who has an obviously deformed and swollen arm after falling and landing awkwardly off a Trampoline? Swing? Monkey bar? Emotions usually ride high and mum and dad tend to blame themselves or each other for what has happened.

Instead, it is much more healthier to accept that accidents do happen and that these are part and parcel of growing up. In today's society where obesity is a growing issue, it is very important for children to play outdoors, whether it is a sport of some kind, or a game of hide-and-seek, so there is no point in 'could have', 'would have', 'should haves'......you can not wrap them up in cotton wool.

The truth is, if there is ever a great time in your life to break a bone, it is when you are a child. At this stage in life, bone can grow much faster and has the ability to re-shape itself back into the correct anatomical position all on its own! This process is known as re-modelling.

How can I tell if my child has a broken bone?

Look out for:

1)    Excessive swelling

2)    Deformity

3)    Inability to move a limb or joint

4)    Shortening of a limb

5)    Pins and needles

6)    Numbness

7)    Localised pain

What should I do?

You need to attend your nearest A & E department ASAP!  There is no point in going to your local GP as your child will more than likely need an X-ray to check if there is a break in the bone and how extensive this is.

Refrain from giving your child something to eat and only give them clear water to drink as they may require surgery.

Give them some paracetamol or ibuprofen to help with any pain.

If you suspect a break at the ankle, it is important to refrain from weight bearing on it as this could do further damage.

What should I expect to happen in A & E?

Assessment & X-ray:

Firstly you will be seen by a triage nurse, who will assess your child and decide whether this is a likely sprain or break. These are very experienced nurses, who have worked in the department extensively and have a very good knowledge of common presentations such as this. They will provide pain killers and if they are in doubt about whether there is a break in the bone, they will arrange an X-ray.

As Doctors, it is part of our assessment to examine carefully how a child may have sustained an injury. This is to protect our children from child abuse, a subject which is particularly relevant in light of recent scandals.

Immobilisation:

Together with the X-ray, your child will then be reviewed by a Doctor to check for any breaks in the bone. If there is a break, then a backslab will be applied to the broken limb. This is essentially a cast made from plaster which will encase the broken area and usually the joint above, in order to immobilise the fracture. This will prevent the break from getting worse and will make things less painful. The cast is also designed to omit a soothing warmth which will also help in keeping your little one more comfortable.

Elevation:

The limb will then need to be elevated to the level of the heart. If the break is in the wrist, elbow or arm, then it will be elevated with the aid of a sling. If the break is in the ankle, then the leg will need to be elevated with the aid of pillows. Elevation is very important as it will help reduce the swelling in the limb.

Swelling?

Your body's natural reaction to a break in the bone is to send help in the form of white blood cells, your body's version of the Red Cross. This is what is known as the body's inflammatory response. This process causes swelling.

The muscles, nerves, arteries and veins in your arm or leg are bundled together and tightly packed within a thin sheath of tissue, called fascia (which looks like cling film), to form a compartment. If too much swelling develops within this compartment, the pressure within it could build up. Should this happen, the pressure could compress these structures and thus compromise the blood and nerve supply to the limb. This is known as compartment syndrome. This is why elevation is so important.

Orthopaedic review:

Last but not least, you may be reviewed by the specialist bone doctors. These doctors may want to admit your child to hospital for a period of observation if the swelling is extensive. They may also want to perform an operation to fix the break. The ultimate decision for an operation and for what type of operation, is usually made in a Trauma Meeting.

This is a meeting attended by several orthopaedic consultants who specialise in different parts of the arm and leg. This means that the best possible plan of action is put together by the specialists for your child.

Here are some common examples of orthopaedic plans of treatment:

Conservative Management

This basically means that your child will not require any operative intervention. This is usually because although there is a break in the bone, the remaining pieces are well aligned and the bone should mend quite nicely without any interference. A cast will still be applied in order to immobilise the fracture to stop it from getting worse. This will be what's called a full cast, which means it will encapsulate the limb all the way around in the shape of a cylinder. The cast will remain on for 4 to 6 weeks and your child will be followed up in fracture clinic as an outpatient in order to monitor the healing process.

MUA

This stands for Manipulation Under Anaesthesia. Essentially, your little one will be put to sleep under a short general anaesthetic in order to move two pieces of bone which are displaced from each other, back into alignment, so that the healing process can continue as normal. The majority of fractures of the arm and wrist are managed in this way.

K wires

Sometimes, once the fracture has been manipulated, it may have a tendency to spring out of place again. It is therefore held in place with metal wires called k wires. These are removed after 4 to 6 weeks, once the fracture has healed well. This is a common method used to fix fractures of the wrist.

Plate

If a fracture is deemed to have a high chance of re-displacing if fixed with wires, then a metal plate will be applied. This is likely to remain in the arm or leg for life. This is a common method of fixing fractures of the ankle.

To Conclude

Although your child sustaining a fracture may be a very traumatic time not only for them, but also for yourself, it is also a great time for you and your child to bond. It will be one of those memorable moments, frozen in time, that you will both recall over the Christmas table in years to come.

Be sure to inform their school teacher of the incident, so that they can accommodate for your child in the classroom. If they are due to take exams, don't forget to request a sick note from the consultant who is treating them as most exam boards will require this in order to arrange special consideration. You will also find that most children are more then happy to help your little one out at school too!

I'd like to take this opportunity to thank my esteemed colleagues and friends in the Orthopaedic department at Worthing hospital for all the training and support they gave me during the time I worked with them.......I dedicate this article to them!

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