Patient Information Resources

Orthopedic Services
Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale, CA 91206
Ph: (818) 409-8000

Pain Management

View Web RX

« Back

Please, please answer this quickly. We have about 20 to 30 minutes to decide. Our eight-year-old daughter fell while speeding around the grocery store on her "heelies" (those sneakers with the light inside). Yes, I am to blame for not supervising her more closely. At the moment, she has a broken wrist and the bones are overlapping. The surgeon assures us that the arm can be cast without doing surgery to pull the bones apart and realign them properly first. She says young children who are still growing will turn out 'normal.' Is this really true? Should we insist on surgery? I don't know what to do.

Situations like this must be treated on a case-by-case basis. The surgeon takes into account the child's age, type of fracture, severity of fracture, and the presence of other injuries. A force strong enough to break a bone can also tear tendons, ligaments, and/or joint capsule. Sometimes the jagged ends of the broken bone can bite into nerves and blood vessels making this a point of consideration as well. Studies show that allowing the type of fracture you described to heal in the shortened position can be quite successful. Surgical manipulation to restore alignment before healing isn't always necessary. The best candidates are children 10 and under who are treated within 72 hours of the injury. A fiberglass cast can be applied from just below the elbow down to the wrist and including the hand. In a recent study of this technique involving 54 children aged 10 and younger, results of treatment were measured based on wrist motion and strength. After the cast was removed, everyone had full wrist motion without pain and good grip strength. Function was excellent. All the children returned to full function and play without limitations or restrictions on what they could do or how they could do it. The absence of any deformities and/or tenderness was also noted. There were no refractures, redisplacement, nonunions, or damage to the growth plates. Any shortness present at first was self-corrected during the healing process. In summary, the authors of the study mentioned showed that surgical treatment to reduce overriding distal radial (wrist) fractures may not be necessary in young children. There was complete healing and bone remodeling in young children (under the age of 11) with this technique. They suggest that this type of closed, conservative care is cost-effective, time-efficient, and safe with excellent results. Surgeons do not need to pursue aggressive treatment when the growth plates are still open. And since the distal wrist growth areas provide 80 per cent of the total forearm length, young children can and do self-correct. In all cases reported, parents agreed they would choose the same treatment approach if they had to do it over again. Even with a short window of opportunity, you may still be able to ask for a second opinion to help you in this decision. But keep in mind, most surgeons do not recommend a treatment that is likely to end in poor results with the possibility of liability from dissatisfied patients and family.


« Back

*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.

All content provided by eORTHOPOD® is a registered trademark of Mosaic Medical Group, L.L.C.. Content is the sole property of Mosaic Medical Group, LLC and used herein by permission.