What you should do about broken bones

Your child is wobbly on new skates. Suddenly, the skates slide out from under her. Her arm breaks the fall--but the fall breaks her arm.

Over the next weeks and months, you and your child will have to work together with doctors and other medical professionals to make sure the arm heals properly for a lifetime of important tasks.

Bones are somewhat pliable, especially in young children. But too much force or stress will cause a fracture, the medical term for a broken or cracked bone. Evidence suggesting a fracture may include:

• Swelling or bruise over the bone
• Deformity of a limb
• Localized pain that intensifies with movement or pressure
• Loss of function in the area of injury

At first glance, not all fractures are obvious, even to a doctor. Most--but not all--fractures hurt so much they make it difficult or impossible to move the injured part of the body. When in doubt, see a health care provider. Proper treatment can prevent serious complications.

"Most fractures in children occur when they are at play," says William J. Shaughnessy, M.D., an orthopedic surgeon at Mayo Clinic. "Overall, 50 percent of children sustain a fracture before they reach adulthood." The most common fractures in children, in order, are of the fingers, forearm, clavicle, foot and elbow.

First aid

If you suspect a child's bone is broken, keep the area of injury as still as possible. Further movement can aggravate injuries to the bone as well as nearby nerves, muscles and blood vessels. Do not try to straighten the bone or test the joint.

In many cases, you may take the child to a hospital or urgent care center yourself if the injury appears to be limited to a simple fracture in the upper extremities. If, however, the injury appears serious, if there are multiple injuries, or if a bone protrudes through the skin, it's best to call for emergency medical assistance.

If the child is faint, pale, or breathing in a notably shallow, rapid fashion, treat for shock--a disturbance of the circulatory system's ability to provide adequate blood to the tissues. Loosen tight clothing and use a blanket to keep the child warm. If possible, elevate the feet higher than the child's head (without moving the broken bone).

If you expect a substantial delay before the child receives medical attention, you can use a splint to immobilize the bone and joints above and below the fracture. It's best to treat shock before applying a splint. Splints are most useful to improve comfort and minimize further injury of lower-extremity fractures.

Splints can be made of wood, plastic, metal, or other rigid materials. The splint should be longer than the bone it supports. Fasten the splint to the limb with gauze or strips of cloth, string, or other material. Start wrapping from the extremity and work toward the torso. Splint the limb firmly to prevent motion, but not so tightly that blood flow is impaired.

The cast room

You can comfort your child in the cast room as a doctor sets the bone back into alignment. The procedure is called reduction. When no surgery is needed, the procedure is called a closed reduction. When surgery is required, it's called open reduction. Because bones are made up of living tissue that renews itself, properly realigned pieces of bone grow back together in time. But for that to happen, the injury must be immobilized by some type of cast, brace, splint, traction, internal screws or metal plates, or an external fixator that secures metal pins inserted into the bone through the skin.

Whatever immobilization device your doctor chooses, it's up to you and your child to take care of it while the bone heals. Follow the advice of your doctor on everything from care of the cast to rehabilitation.

For casts, such advice includes:

·              ·         ·         Reduce swelling by using pillows to keep the broken limb elevated above the heart.

• Keep the cast dry and prevent crumbs, dirt, sand or other objects from getting inside it. (More expensive cast liners are available to allow the cast to be submerged in water.)
• Avoid sticking objects into the cast to scratch itching skin.

Call your doctor or seek medical attention in the event of:

·              ·         ·         Increased pain

• Swelling not relieved by elevating the cast
• Numbness or tingling in the affected limb, or decreased movement in fingers or toes
• Cold fingers or toes even after they are covered
• An unpleasant odor or drainage from inside the cast.
• Change in skin color near the cast
• An object dropped into the cast
• A weakened, cracked cast or a cast that feels too loose or too tight

Tell your child that there's a benefit to following the doctor's advice: A child's fracture, if properly treated, typically heals twice as fast as an adult's