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There are several types of bone fractures that may occur in children, including:

• Greenstick or Buckle – an incomplete fracture in which the bone bends or buckles without completely breaking; frequent in small children.
• Open (or Compound) – the fractured bone breaks the skin.
• Closed (or Simple) – the fractured bone doesn’t break the skin or outer tissues.
• Comminuted – a fracture of three or more relatively small fragments.
• Displaced – the bone cracks completely in many pieces that move out of alignment.
• Transverse – a fracture that goes across the bone’s axis.
• Spiral – a fracture that runs around the axis of a bone.
• Oblique – a fracture that goes at an angle to the axis.

What are the most frequent bone fracture treatments?

The most frequent bone fracture treatment options are the following:

• Splint or Plaster Cast.
• Open reduction with internal fixation (ORIF).
• Open reduction with external fixation (OREF).
• Closed reduction with external fixation (CREF).

The needed treatment will depend on the type of bone fracture.

What are the main differences among these bone fracture treatments?

• Splint and Casting are non-surgical options. Splints are mostly used in cases of incomplete fractures and casts are used for closed, standard fractures. Always follow your doctor’s instructions completely.
• Open reduction with internal (ORIF) or external fixation (OREF), and more rarely together, are options that require orthopedic surgery. ORIF is a recommended surgical procedure in case of complicated bone fractures not able to be realigned (reduced) by casting, or in case the long-term use of a cast is not desirable or indicated. The orthopedic surgeon will operate while your child is under general anesthesia, and will apply metal rods, screws and/or plates to repair the bones that will remain in place under the skin after surgery. OREF is a surgical procedure that involves the use of an external fixation device to support the bone and hold it firmly in the correct position while it’s healing. The orthopedic fixator is connected to the bones with bone screws, commonly called pins, and will be removed when healing is achieved. OREF is recommended in case of quite complex fractures that cannot be repaired using open reduction with an internal fixation device.

Who decides the best treatment options?

The treatment your child needs will depend on the type of fracture, age, overall health and medical history of your child. Each child is different and your orthopedic surgeon – a doctor specialized in conditions related to bones health, ligaments, tendons and muscles – will discuss with you the necessary and best treatment for your child’s bone fracture. Your orthopedic surgeon will also share with you your child’s recovery plan and will be with you along the entire treatment to ensure the treatment is proceeding as intended.

What to expect after surgery with an external fixator?

In case your child’s limb has been realigned with the use of an external fixator, your orthopedic surgeon will give you an estimate of how long your child’s recovery will take, as it depends on many factors: type of bone fracture, child’s age, overall child’s health and other co-factors. During the healing process, it’s important that your child stays active and starts mobilizing as soon and safely as possible: playing, going back to school, keeping up his/her daily routines. When back home, your child should meet other children and friends, enjoying their company to overcome the initial stress and limitations, and always following the instructions provided by the surgeon and hospital staff.

In case of treatment with orthopedic external fixator, why is pin-site care so important?

The pin-site is the area of skin crossed by pins or wires of the external fixator: it has to be checked carefully every day and kept constantly clean to prevent infections of your child’s limb. It’s very important that you follow exactly the instructions provided by your orthopedic surgeon and hospital staff.

How long does an external fixator stay on?

The hardware will be removed from your child’s limb when the orthopedic surgeon is completely satisfied with the alignment and consolidation of the bone. Your child might need to wear a cast for a short while after the fixator frame has been removed.