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Broken Bones – Frequently Asked Questions

How do I know if my child has a broken bone?

The only sure way to tell if your child has a broken bone is to take an x-ray. If the arm or leg is obviously deformed, then the problem is obvious.   However, some fractures are so minor that they cannot be detected by just looking at the arm.  Typical hints that the bone is broken are persistent pain after a fall, point tenderness directly where the child says it hurts, swelling, or the a young child refusing to use the arm at all.  With these findings, it is advisable to see your doctor and have an x-ray.

How do fractures heal?

When you break a bone, your body is programmed to begin a process that will “knit” the bone back together and heal.  Bone is a living tissue, just like your heart, brain, liver, or skin. When you break a bone, it is not like breaking a stick of wood; the bone will bleed, and immediately the healing process begins by recruiting cells from the bloodstream that are capable of healing the fracture.

Technically speaking, a fracture triggers a process in which cells in your bone change from a resting state and become very active at making new bone.  This process produces what is called “fracture callus”.  When your doctor shows you the x-ray of your fracture healing, it will look like a big ‘lump’ of bone where the fracture occurred. Sometimes when you feel your arm during the healing process, you can feel this lump, which is normal.  Once the ends of the bone have knitted themselves together, your body will then begin a process of remodeling of the fracture callus.  In most kids, the bone will eventually return to its normal appearance and it will be difficult to tell if there ever was a fracture.

What is a growth plate?

Every long bone in the body has a growth plate at each end.  This is a remarkable structure made up of a highly specialized growth cartilage that allows the bone to grow longer as the child gets older.  Growth plates function until the child completes their growth (girls at about 14 and boys at 16), and then the growth plates close.

How does the growth plate work?

Growth plates are made up of a highly specialized material known as cartilage.  This cartilage has cells that are programmed to divide and then undergo a process in which the body changes the cartilage to bone.  This is a very orderly process, and continues until you finish growing.

What happens if the growth plate is injured?

Some fractures in children will involve the growth plate.  If this is the case, then there is some chance that the growth plate will no longer work properly.  Fortunately, this is usually not the case.  Anytime a fracture involves the growth plate, it will need to be watched by your doctor until it is certain that normal growth has returned.

If the growth plate is permanently damaged, it can result in the arm or leg either growing crooked or not growing at all.  These problems can be very complicated, depending on the age of the child when the injury occurs, and require the expertise of an orthopedic surgeon used to dealing with these types of problems.

My childs arm looks crooked.  How can it grow straight?

Kids have an incredible capacity for their arm or leg to grow straight after their broken bone has healed. Orthopedic surgeons call this process “remodeling”.  Remarkably, your child’s bones are genetically programmed to grow back into their original shape over time.  This is often an important issue because when you look at an x-ray and your child’s arm or leg does not look perfectly aligned, you will wonder if it will ever be “right” again. Ask your surgeon to show you an example of how kids bones remodel with growth and you will be amazed at their capacity to grow straight again.

Do the bones have to be perfectly aligned on the x-ray to heal properly?

No.  The  bones will heal regardless if they are aligned end to end, side-to-side, etc.  The overall alignment of the bone is more important than the position of the ends of the broken bones themselves.  Kids have an incredible ability to heal their broken bones quickly.

Is the bone stronger after it has been broken?

This is a tricky question.  In general, we don’t go out and try to re-break your child’s broken bone to see how strong it actually is!  However, there is an time right after the final cast is removed that your child’s bone is probably weaker than it was before the break.  This is a time when you may want to try to limit your child’s more dangerous activities.  When the bone is completely healed, the diameter of the bone can be bigger; in this instance, the bone is actually stronger until is completely remodels back to the normal, pre-fracture state.

How do I tell if the growth plate is growing properly?

If the growth plate was involved in your child’s fracture, then your orthopedic surgeon will need to watch the growth of the arm or leg over time.  As the fracture heals, growth usually returns.  You can see this on an x-ray. The body will form what doctors call a “growth line” right next to the growth plate.  Over time, this growth line will move away from the growth plate, confirming that normal growth has resumed.  Growth lines are interesting. They are essentially an archeological record of an injury, somewhat like the growth rings on a tree.  They will help you remember the good and the bad years of growth! (or the ones where you spent your summer in a cast…)

If my child has a growth arrest, what can be done?

Unfortunately, a growth arrest after a fracture can occur from time to time.  The significance of a growth arrest depends on many factors, including the age of your child, the bone involved, and the type of growth plate injury.  In certain cases, only part of the growth plate is injured and this can be repaired with surgery.  This requires the expertise of a pediatric orthopedic surgeon who is familiar with treating these types of injuries.

Why does my child have to wait to have an anesthetic if they are in pain?

When an anesthetic is administered the sphincter at the bottom of the esophagus relaxes and if the stomach is full, those contents can be regurgitated and spill into the trachea and contaminate the lungs.  This is called an “aspiration” and it can cause severe problems such as a terrible pneumonia or inflammatory reaction in the lungs that can be life threatening.  In order to reduce the chance of aspirating, the American Society of Anesthesiologists have developed a set of guidelines for how long someone should go without food before having an anesthetic.  The suggested times are as follows:

 

Ingested Material Minimum Fasting Period

clear liquids — 2 hours

breast milk — 4 hours

infant formula — 6 hours

non-human milk — 6 hours

light meal —  6 hours

  • These recommendations apply to healthy patients who are undergoing elective procedures.  They are not intended for women in labor.
  • Following the guidelines does not guarantee that complete gastric emptying has occurred.
  • The fasting periods apply to all ages.
  • Examples of clear liquids include, water, fruit juices without pulp, carbonate beverages, clear tea, and black coffee.
  • Since non-human milk is similar to solids in gastric emptying time, the amount ingested must be considered when determining an appropriate fasting period.
  • A light meal typically consists of toast and clear liquids.  Meals that include fried or fatty foods or meat may prolong gastric emptying time.

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