Broken Arm (ER Story)

Five-year-old Connor Ivey was at school playing on the monkey bars when he fell and hurt his arm. “His teacher apparently was not impressed enough to call his mom about it, and actually, talking to Connor, it seemed like the pain got worse over time,” explains Dr. Kathleen Nelson, professor of pediatrics.

When his mom got home that evening, she took him to the emergency room. He complained of pain and could not move his arm. The signs didn’t point to a definite break, but an x-ray should show if there is a major break.

“Oh boy, oh boy, oh boy,” exclaims Connor jumping down the hallway to the x-ray room. It seems that this is just the thing to take Connor’s mind of the pain.

When the x-rays come back there is no sign of a major break, but as the radiologist explains “there’s some swelling around the elbow joint here, which is indicative of some bleeding in the joint, and that’s a warning sign that there might be a small fracture in there.”

In the meantime, they put his arm in a splint and in a few days he will need to see his doctor to make sure his arm is getting better. “Well,” says Doctor Nelson watching Connor and his brother make faces, “it looks like he’s feeling a whole lot better already.” “Yeah, he sure is,” says his mom, “hopefully it’s not really a fracture at all.”

So, was it worth it to go to the emergency room? This five-year-old boy thinks so. He can’t wait to get home and tell his best fried Noah, “I gotta tell him,” he declares.

A broken arm is a common injury. The American Academy of Orthopaedic Surgeons (AAOS) says that children are more likely than adults to break the lower arm bones (radius and ulna), especially children who are active. The AAOS says you can you determine if your child has a broken arm by looking for the following signs and symptoms:

• Extreme pain at the site of the injury
• Pain increased by any movement
• Loss of normal use of the arm
• Dizziness or chilly feeling, due to shock

If you think your child has suffered a broken bone, it is important to take action quickly. The Nemours Foundation offers the following advice for the immediate management of your child’s injury:

• Stay calm.
• Make sure your child is as comfortable as possible.
• Take your child to the emergency room or call 911.
• Do not move the broken bone. You may be able to cushion or support the surrounding area with towels or pillows.

When your child has a broken bone, the doctor will need to take X-rays in order to set it correctly. According to the Phoenix Children’s Hospital, most simple bone breaks will develop no further damage if that body part is kept at rest. Your child will likely need a cast, and the doctor may elect to give him/her a sedative as a calming effect.

An X-ray is the most common type of diagnostic procedure used in an emergency room visit. If a fracture is suspected, the physician may also use magnetic resonance imaging (MRI) and computed tomography scan (also called a CT or CAT scan), especially if the fracture is internal.

Treatment for your fractured child will vary depending on the type and location. The Virtual Children’s Hospital says that in general, the physician will probably recommend R.I.C.E. treatment (rest, ice, compression and elevation):

• Rest the injured area. The doctor may ask your child not to participate in physical activities for a time.
• Put ice on the injury to bring down swelling.
• Ask the doctor about using compression.
• Elevate the injured area (keep it propped up on a pillow).

With a more serious fracture, the physician will immobilize and cast your child’s injured limb. The Lucile Packard Children’s Hospital cites these additional treatment options:

• Splint/cast – This method immobilizes the injured area to promote bone alignment and healing to protect the injured area from motion or use.
• Medication – This strategy helps manage pain.
• Traction – Oftentimes, force is applied to stretch certain parts of the body in a specific direction. Traction consists of pulleys, strings, weights and a metal frame attached over or on the bed. The purpose of traction is to stretch the muscles and tendons around the broken bone to allow the bone ends to align and heal.
• Surgery – This treatment option is required to put certain types of broken bones back into place. Occasionally, internal fixation (metal rods or pins located inside the bone) or external fixation devices (metal rods or pins located outside the body) are used to hold the bone fragments in place to allow alignment and healing.

All injuries take time to heal. The Nemours Foundation suggests that fractures heal at different rates depending upon the age of the child and the type of fracture. Young children may heal in as little as three weeks, although it may take six weeks for the same kind of fracture to heal in teens.

As a parent, you can take several steps to minimize your child’s chances of suffering a fracture. The AAP offers the following safety measures to help prevent fractures in your child:

• Never leave your baby unattended on a changing table or bed.
• When driving, always place your child in a well-secured car seat in the rear seat.
• Don’t start the car until all seat belts are fastened.
• Make sure your child wears protective gear (wrist guards, helmets, knee pads and mouth guards) that meets U.S. safety standards when playing sports.
• Never allow your child to roller skate, ride a bicycle or go in-line skating or skateboarding without wearing a helmet.

Growing pains and fractures come with the territory of raising children, but providing a safe recreational environment is part of the prevention process.

American Academy of Orthopaedic Surgeons
Children’s Hospital of Pittsburgh
Nemours Foundation
Phoenix Children’s Hospital
American Academy of Pediatrics
Lucile Packard Children’s Hospital
Virtual Children’s Hospital