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Fracture Clinic

Few kids grow up without breaking a bone. Prompt, expert care of fractures and orthopaedic injuries, especially those involving a bone’s growth plate, helps ensure that childhood misadventures don’t create problems into adulthood.

When an injury happens, our Fracture Clinic offers quick access to specialized care.

We work to evaluate and treat every child in a timely window. Our orthopaedic specialists are familiar with a child’s unique build and know precisely the right treatments to minimize future problems.

Our clinic’s four-bed casting room is the ideal spot for children who need a cast. Movies, games and books help distract from the injury, and child life specialists put children at ease by going through the casting process with a doll’s arm first. Patients then have their pick of bright cast colors and glitter for a special touch. When it’s time to remove a cast, our technicians make children feel comfortable by demonstrating the dull saw on their own hands and providing headphones to cover up the saw’s sound.

Other procedures done at our Fracture Clinic include pin removal, suture and staple removal, bone setting and realignment, and splinting.

To make an appointment at our Fracture Clinic or ask follow-up questions about your child’s care, please call (888) 770-2462 and press 2 for specialty care clinics. Referral and authorization from your child’s primary doctor is usually required. We will provide timely follow-up and care coordination with your child’s doctor.

Traumatic Injuries

When a traumatic orthopaedic injury occurs, care often begins in our pediatric-dedicated emergency department. Our orthopaedic surgeons are always on call and can evaluate your child with an expertise not found at adult emergency departments. Should your child need an MRI, CT scan or other testing, these services are located within steps of the emergency department for the convenience of our families. Learn more about our emergency department.

Splints and Casts

Broken bones, or fractures, are a common childhood hazard, particularly for kids in sports. While it can happen in a split second, a broken bone takes time to heal and may often require a cast. Splinting is used during the first few days after the injury, to allow for any swelling that may occur. A child may be given a splint prior to a cast.

Having a cast put on is a relatively simple process. First, a non-itch cloth liner is placed around the injured area, followed by several layers of soft cotton. Next, the doctor or orthopedic technician wraps a layer of plaster or fiberglass around the soft first layer. The outer layer is damp but will dry to a hard, protective covering.

Once the bone is healed, the cast will be removed with a small electrical saw. The saw blade isn’t sharp — it has a dull, rounded edge that vibrates up and down. This vibration is strong enough to break apart the fiberglass or plaster but won’t hurt skin. Even so, the process can seem scary to a child. Our child life specialists will help put your child at ease using distraction and calming techniques, as well as by using child-friendly terms to explain what’s happening.

Once the cast is off, the injured area will probably look and feel different to your child. The skin will be pale, dry, or flaky; the hair will look darker; and the muscles in the area will look smaller or thinner. This is all temporary. Over time, with some special exercises recommended by the doctor or a physical therapist, the bone itself, and muscles around it, will be back in working order.

Kids and Broken Bones

When a child takes a fall, they may impact their growth plate. What is a growth plate? “It’s a [developing] area of the long bone, like the femur or tibia that contributes to the length of your body,” says Dr. Francois Lalonde. Located close to a joint, including the hip, knee or ankle, the growth plate  remains open until age 15 for girls and age 17 for boys. “Luckily, most growth plate injuries don’t cause any damage to the growth of the bone,” says Dr. Lalonde. “Most kids will get their motion back around the joint on their own.” Read more about preventing growth plate injuries in this health feature at choc.org/health.

Girl and skateboard

Frequently Asked Questions about Fractures and Casts

Growth plates, located near the ends of long bones, help regulate and determine a bone’s eventual shape in adulthood. However, growth plates are very soft and vulnerable to fracture. They also heal very quickly, which gives us a very short window to do minor, non-surgical manipulations to set broken bones correctly. Ideally, a growth plate fracture should be set within a week of injury. After that, surgery is necessary to prevent a life-long deformity.
An estimated one-third of growth plate injuries occur during competitive sports such as football, basketball or gymnastics. Monkey bars, skateboards, snowboards and “heelies” (roller shoes) are also very rough on young wrists, arms and elbows. Wrist guards provide some protection, but more importantly, children should always wear a helmet when engaging in those activities.
Many injuries are immobilized with a splint or a cast. Learn how a cast is applied and how you can care for it at home. Some breaks are treated with traction, when the body part is forced in a certain direction to allow the bone to align and heal. Surgery, with the use of metal rods or pins inside or outside the body, is also used to align the bone while it heals.
If there is an obvious deformity or your child is experiencing a lot of pain or swelling, contact your pediatrician. If it is after regular office hours, you may be directed to an urgent care clinic or emergency department. Be sure to follow up with a pediatric orthopaedic specialist as soon as possible.
There are two types of cast – one made of hard plaster and the other a fiberglass shell. Both work to prevent movement of the broken or fractured bone, and allow proper healing to occur. The amount of time a cast has to remain on a child depends on the type of injury.
Your child should not get her cast wet. This is best avoided by taking a sponge bath, while still covering the cast with several layers of a towel or plastic bags. In the event a cast gets wet, dry it with a hair dryer on the cool setting.
Elevating the affected limb for the first 24 hours significantly reduces the natural swelling that occurs after an injury. Place the injured limb above the level of the child’s heart (the “high five” position for arm injuries), using pillows as support. Moving fingers or toes on the affected limb may also assist in swelling.
Tapping on the cast or blowing cool air inside the cast with a hair dryer can help alleviate itching. Under no circumstances should an object be placed under the cast to scratch. This may cause injury or infection. Over-the-counter Benadryl also may help stop the itching. If the itching becomes severe or persistent, speak to the child’s physician.
The most common symptoms of a cast that is too tight are:

• Numbness, tingling
• Increased pain
• Change in skin color compared to the unaffected limb (pale or blue, by comparison)
• New swelling of the fingers or toes

Keep in mind that swelling is expected in the first 24-72 hours, which may make the cast feel tight. Elevating the injured limb should help reduce the swelling. Once the swelling subsides, the case may then feel loose. As long as the child cannot move the limb under the cast or take the cast off, he is fine.
Unfortunately, cast odor is normal since the affected limb cannot be bathed. Never apply powder or perfume on or inside the cast.
Children should enjoy being kids, and there should be no restrictions to activities of daily living. However, they should avoid activities that can damage the cast, including getting it wet, or re-injure the limb. This may include swimming, bicycle riding, skate boarding, contact sports, etc.

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UC Irvine

CHOC Children's is affiliated with the UC Irvine School of Medicine