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

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We took our son to the emergency department after a bad fall from his bicycle. The doctor there X-rayed it and saw that both bones in the forearm were broken. She tried to reset the bones without doing surgery (they gave our son a mild sedative). But it didn't work so he ended up having a surgeon do this in the operating room. We are wondering if the emergency room doctor could have gotten it if she had tried again but we don't have any way to know for sure. What do you think?

The idea that "if at first you don't succeed, try, try again" may not apply in cases like this one. If the child is adequately sedated and not in any pain and the fracture is easy to realign, then closed reduction (name of the procedure when someone resets the bone without surgery) might work. But if there are multiple bone fragments, the bones are separated too much (called displacement), or the joint is dislocated, then open reduction is often necessary. At that point, the surgeon will likely use metal plates and screws, wires, or pins to hold the bones together while the fracture heals. Emergency personnel trained in closed reductions know what they can and can't do to reset a bone fracture. A general guideline for them is to spend no more than 20 minutes of effort attempting a closed reduction. After that surgery is needed. There are often concerns about blood flow to the arm, the jagged edges of the fractures cutting into important blood vessels, or infection. These concerns dictate that surgery is the appropriate step. It is possible that some health care personnel may be more skilled at closed reductions than others. They may simply have more opportunity to practice this skill. You are fortunate your child was cared for by someone who recognized her limitations and referred you to a surgeon.


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