Broken (fractured) bones heal quite quickly in children, so they are usually only put into a cast for 4-6 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’ at 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.
Caring for your new cast is very important. You must keep it dry, and watch for signs that the cast is becoming too tight (from swelling) or too loose.
What to Do in the First Days at Home
- You should elevate the cast to the level of the heart for the first 3 days to keep the swelling down. You will have to keep the child reclined to elevate a leg cast.
- Every hour, while awake, the child should try to gently move uninjured fingers or toes. This will also keep the swelling down and encourage circulation.
- Ice (in a sealed plastic bag) can be applied on or next to the cast. This will help with pain and swelling.
- If your child is complaining of pain, your doctor may recommend an over-the-counter pain medication.
Watch for signs that the cast is becoming too tight such as:
- Increased pain or throbbing inside the cast
- Numbness, tingling or “pins and needles” feeling in fingers/toes
- Skin under the cast feels like its burning or stinging
- Gray/Blue discoloration of fingers/toes
(Press gently on the nail bed, it will turn white. When you let go, it should turn pink in 2-3 seconds.)
- Unable to move fingers/toes at all
- Keep the cast clean and dry.
- Your child should not put anything down inside the cast, including his fingers. If he does, it may cause a sore or infection. Pushing things into the cast may bunch up the cast padding and irritate the skin. This may also push the padding away from the skin, and put your child at risk for a cut or burn when we remove the cast.
- Your child should not pull the padding out of the cast. The padding protects the skin from rubbing and sores.
- Do not use lotions, oils or powder on the skin under the cast.
- If your child complains of itching: use a blow dryer set on cool to blow air down the cast or try scratching another part of the body.
- Keep dirt and sand away from the cast.
- Wrap walking casts in plastic bags if it is raining. Avoid puddles.
- Always wear a walking shoe for walking casts.
- Do not allow walking in a long-leg or spica cast.
Bathing and Hair Washing
No showers. Sponge baths are best. Supervised shallow water tub baths are OK with short arm or leg casts. Seal the cast in plastic bags, and then hold it out of the tub higher than the rest of the body.
Washing your child’s hair:
- You may lay a small child down with his head in the sink and wash the hair.
- You may lay a child across a bed and place a bucket on the floor to catch the water as you shampoo.
- Liquid No Rinse shampoos are available as well.
Returning to School/Day Care
The healthcare provider will tell you when your child can return to school. Generally your child should be off of narcotic medication during the day before returning to school. Your child will be given a school note stating activity limits, which may include no gym or recess. Your child should not ride a bike, roller skate, climb on a jungle gym or other such activities while in an arm cast.
When to Call the Doctor
- Your child has severe pain and the pain medication does not help
- You see a change in the cast: cracking, softening, or drainage from the inside.
- You smell a bad odor coming from the cast
- Your child’s fingers are cold, blue/gray or swollen.
- Your child feels numbness or tingling in the fingers
- Your child cannot move his fingers
- There is a change in the position of the fingers in the cast or the cast looks like it is slipping off.
- Fever with no other signs of illness (temperature over 101.5 F) (no cold, ear ache, etc.)
Weekdays: Please call the Orthopaedic Department at 510-428-3238.
Nights or Weekends: Call the main Hospital at 510-428-3000 and ask the operator to page the Orthopaedic Resident on call.
If you have questions, please contact Children's Orthopeadic Clinic or request a referral from your pediatrician.