Broken (fractured) bones heal quite quickly in children, so they are usually only put into a cast for 4-8 weeks. By this time, the bone has had time to lay down a thick layer of new bone called “callus” around the fracture to hold it in place. You may be able to see and/or feel this hard “knot” or “bump” of the callus. Over the next several months, the bone continues to heal, removing the rough edges, remaking the hard outer covering and the marrow inside, and removing the extra layers of callus. During this “remodeling”, the body can straighten the fractured bone by laying new bone on the inside edge, and taking away bone on the outside of the angled area. In young children, bones can remodel fairly large angles, healing to appear completely normal within one to two years.
After the cast is removed, it is normal for there to be some discomfort in the bones and joints that were immobilized, for the arm or leg to be smaller than the other side, and for the skin to have some changes (dry skin and more hair).
A few baths in warm water will soak off the dry, flaky skin. This may take a few days, but be patient and avoid scrubbing the skin. You may apply some lotion to soften the skin, if desired. The hair will return to normal over several months.
The casted area may be tender for a few weeks. The child should avoid jumping, climbing, running or activities with a high risk of falling for a period of time after the cast is removed. This also includes sports. Your doctor will give you specific instructions on the amount of time that these activities should be avoided. It is common for children to limp for a few weeks after a leg cast is removed (up to a year for a thigh/femur fracture). The child may limp with or without pain. If the limping becomes worse, not better, over the first 2 weeks, or if the pain persists, you should return to be rechecked.
Most children do NOT need physical therapy to walk or move normally again. Routine activities and play is usually enough for children to return to normal within a few weeks to months. Following a joint fracture, it may be helpful to do gentle exercises twice a day. You can have the child move the healing extremity through all of its motions, using the other arm or leg to judge what normal is. Children who do not regain normal motion after a month or two should be rechecked.
If you have questions, please contact Children's Orthopeadic Clinic or request a referral from your pediatrician.