Many kids who break a bone do just fine with a simple cast, but sometimes, a child needs an operation to help the fracture heal the right way.
Robyn Parets, a small-business owner in Boston whose teenage son is a ballet dancer, learned firsthand that surgery can sometimes be the best option.
In the winter of 2015, her son was in rehearsal for the musical Billy Elliot. "Noah broke his right arm in two places while doing a back handspring," Parets says. "He actually heard the bone snap."
Noah had surgery to put a metal pin in his arm. "This was so the one bone -- the more serious break of the two -- could heal properly," Parets says.
It's possible your child may be in the same situation. "There are certain fractures that will not heal well unless the position is held in place with pins," says David S. Feldman, MD, a professor of orthopedic surgery and pediatrics at NYU Langone Medical Center.
Common Reasons for Surgery
"Different bones do different things when they fracture," says Donna Pacicca, MD, an orthopedic surgeon at Children's Mercy Hospital. "There are specific fracture patterns that are better treated with surgery." Without it, your child might not be able to move his limb as well when it heals.
Your child might need surgery if:
The bone pieces need help staying together. If he needs pins, screws, or plates to hold the bone in place, like Noah did, he may need surgery.
The break goes through a joint. If your child's fracture disrupts a smooth joint surface, it may not heal the right way without an operation.
It's an elbow fracture. It's common for a break on that spot to cause the bone to move out of the right position. You may hear the doctor call this "displaced" or "angulated."
Bone fragments break through the skin. If this happens, or your child has a wound that goes down to the broken bone, it's called an "open" or "compound" fracture. There may be extra damage to muscles, tendons, and ligaments. There's also a higher risk of infection.
Doctors have different views on the best way to handle open fractures. "There is debate about whether they all require surgery as part of treatment," Pacicca says.
It's a "growth plate" fracture. As the name suggests, it's an area near the end of your child's long bones that affects how well they grow. When a fracture causes damage there, Pacicca says, it could cause long-term problems for the way your child's bones grow. Surgery may curb the risk of trouble.
It needs new alignment. The doctor may take X-rays after your child has been in a cast for a while to make sure the broken bones are still lined up right.
"This is commonly done in the first 1-2 weeks after fracture, as the swelling goes down and casts can loosen," Pacicca says. If it's not on track, he may want to change the position of the bone through surgery.
Making the Decision
If you're concerned about surgery, try to remember that it's usually recommended because it's the best thing for your child's long-term health.
"Interestingly, as a pediatric orthopedic surgeon, I am not trying to sign up every kid for surgery," Pacicca says. "The important thing to note is that bones heal without surgery, but might not heal in the right position."
Parets had to make the decision twice. About 6 weeks after his surgery, Noah's doctor removed his pin and he returned to his dance training. But just a few months later, he broke another bone. This time it was his right ankle. It was in an obscure bone called the os trigonum, which only a small number of people have and isn't necessary for normal foot function. It had to be surgically removed to prevent another break in the future, Parets says.
"As a mother, my main concern was that the arm and ankle would heal properly and that he would have full use and flexibility once he did heal," Parets says. "Ballet is his life, and I was concerned the surgery might impact his dancing."
Noah's surgeon explained that an operation was necessary and with the right rehab, he'd regain his strength and dancing ability. Parets knew she didn't really have a choice, so they moved forward with surgery. "Plus, he would never have this injury again, as the bone is now gone," she says.
If your child needs surgery, choose a doctor who's experienced in treating kids' fractures. "Children are not little adults," Feldman says. "They have special needs in caring for their fractures."
After three breaks and two surgeries, Parets can finally take a deep breath. "Noah is doing great," she says. After performing at the Boston Opera House, he's on his way to Philadelphia, where he'll train with a contemporary dance company and then perform with the Pennsylvania Ballet.