Bone, Muscle, and Joint Trauma

What should I do if my child breaks a bone or dislocates a joint?

A broken bone or dislocated joint is a serious injury that requires a doctor's immediate attention. The best thing you can do is protect the injured area, making sure your child doesn't worsen the damage.

Fractures are breaks, cracks, or chips in a bone. A fractured bone that pierces through the skin is called an open fracture. Because of bleeding and the risk of infection, open fractures are the most potentially dangerous. Fortunately, closed fractures, which do not break the skin, are the most common kind. A dislocation occurs when the bone slips out of its normal place in the joint.

Three important cautions:

• Never attempt to straighten or change the position of a dislocated joint or broken bone. You could make the injury worse.
• Unless absolutely necessary, don't move your child if you suspect a broken neck, back, or pelvis; call 911 immediately. Keep your child still and wait for medical assistance.
• Call 911 if your child shows symptoms of shock or of internal bleeding:
• weak, rapid, or irregular pulse
• clammy or bluish skin
• rapid, shallow breathing
• confusion, anxiety, or loss of consciousness
• coughing up or vomiting blood
• visible head, chest, or abdominal wounds

What if I don't know whether the bone is broken?

If you don't know the extent of the injury, treat it as if it's a broken bone until you see the doctor.

What if the bone protrudes through the skin?

If the bone has broken the skin -- an open fracture -- don't wash or probe the injured area. Cover it with a clean cloth and tie a bandage over it to stop the bleeding. Call the doctor immediately, or take your child to the nearest emergency room.

Is it safe to move my child?

Unless you suspect a serious injury to the head, neck, or spine, it should be fine to move him. But it's important to immobilize the injured bone or joint first. This will minimize any further injury and will make moving your child easier. The method you use for protecting the injured area depends on where the injury is.

For a broken arm, wrist, or hand:

If the hand or upper arm is injured, make a sling to support the arm. Find a large piece of cloth and fold it into the shape of a triangle. Gently slide the wide part of the triangle under the injured arm. Tie the loose ends around the neck. Make sure the sling is tied tight enough to hold the arm snugly but not so tight that you cut off blood flow.

If a bone in the forearm or wrist is fractured, gently support the injured area and place the lower arm on a folded newspaper or magazine padded with a towel or pillow. This creates a splint that immobilizes and protects the broken bone. Tie the splint around the arm using cloth strips; place the strips on either side of the injured area. After securing the splint, make a sling to support the arm (see above).

For a broken finger:

Raise the finger above the level of your child's heart. This will help minimize swelling. Apply a cold compress for 10 to 15 minutes. To splint the broken finger, place a piece of cloth or cotton between the injured finger and an uninjured one. Then tape the two fingers together.

For a broken leg:

If the injury is to the lower leg (below the knee), make a splint. Boards or broomsticks work best. If they aren't available, you can use a blanket. Place one board on the outside of the leg, extending from hip to heel. Place the other on the inside, extending from groin to heel. Pad the boards with blankets or pillows to protect the injured leg. Then tie the boards in place at the groin, thigh, knee, and ankle using cloth strips. For a blanket splint, roll up the blanket and place it between your child's legs. Then tie the legs together at the groin, thigh, knee, and ankle.

If the injury is to the upper leg or hip, don't move your child unless absolutely necessary. Call 911 for help. If you must move your child, make a splint with boards. One board should extend from your child's armpit to his heel. The other should reach from groin to heel. Pad the insides of the boards with towels or pillows, and tie them in place with cloth strips at your child's chest, waist, groin, thigh, knee, and ankle.

For a dislocated joint:

Like broken bones, dislocated joints require immediate medical attention. The most important thing you can do is prevent further injury to the joint. Don't try to straighten it. For a dislocated shoulder, make a sling to help minimize movement. For a dislocated finger, tell your child to protect the injured finger by holding the hand gently against his chest. For a dislocated toe, carry your child or support him so that he doesn't put weight on the injured foot.

Once you've immobilized the injured area, call the doctor immediately. If you can't reach your pediatrician, go to the nearest emergency room.

What can I do to ease my child's pain?

Over-the-counter pain remedies like acetaminophen and ibuprofen can help reduce the pain that follows a broken bone or dislocated joint. Ice packs applied to the site of a dislocation can reduce swelling and ease discomfort. For serious injuries, your doctor may suggest a prescription pain reliever.

Further Resources

National Institute of Child Health & Human Development
http://www.nichd.nih.gov/default.htm

References

Pantell, Robert H. M.D., James F. Fries M.D., and Donald M. Vickery M.D. Taking Care of Your Child: A Parent's Illustrated Guide to Complete Medical Care, Eighth Edition. Da Capo Lifelong Books.

What Parents Should Know About Broken Bones. Mayo Foundation for Medical Education and Research.