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Broken Toe? Treatments Can Help These Small Bones Heal

Broken Toe? Treatments Can Help These Small Bones Heal

by | Oct 30, 2023 | Fractures

Broken toes are a common injury among children, who frequently stub their toes, drop heavy objects on them or close them in doors or cabinets. If your child breaks a toe, you, like many people, may assume nothing can be done. That’s a common misconception. Your child’s provider has many options for treating broken toes, and treatment is less complex than you may think.

Broken toe treatment can reduce your child’s pain and help them get back to being a kid.

Signs Your Child’s Toe May Be Broken

Each toe consists of two or three bones, as well as toe joints. Broken toes can range in severity from small hairline toe fractures to multiple breaks in a bone. 

Symptoms of a broken toe include: 

·       A crooked toe or toe that appears to be out of place 

·       Bruising and swelling, which may appear the day after the injury

·       Difficulty walking

·       Pain at the specific area of injury, also known as pinpoint pain 

·       Stiffness 

If you suspect your child has a broken toe, visit your child’s pediatrician or an urgent care clinic. Visit an emergency room if your child has an open fracture, in which bone has broken through the skin. Open fractures can become infected and need immediate care.

Often, health care providers can diagnose a broken toe with a physical exam. Your child’s provider may order an X-ray to find the exact location of the break and determine whether the toe is dislocated.

How to Treat a Broken Toe

Broken big toes and severe fractures may require casting and, rarely, surgery. However, most broken toes will heal with at-home care or basic medical treatments. Your child’s provider will likely recommend one of the following:

·       Rest. Your child will need to avoid putting unnecessary weight on the injured toe. Elevating the foot on a pillow can help with swelling.

·       Ice. Ice packs can also reduce swelling when placed on a broken toe for 10 to 20 minutes every one to two hours. Apply ice for three days or until the toe is no longer swollen.

·       Over-the-counter pain relievers. Acetaminophen (Tylenol®) and ibuprofen (Advil® or Motrin®) can reduce pain but follow dosing instructions closely. Do not give children aspirin unless their provider says it’s OK. Aspirin can increase the risk of Reye syndrome. 

·       Proper footwear. If your child needs to wear shoes, have them choose a wide, stiff-bottomed shoe that doesn’t put pressure on the injured toe but also keeps it in proper alignment. Depending on the extent of the fracture, your child’s provider may recommend a special boot while the toe heals.

·       Splinting. Your child’s provider may recommend a toe splint to hold the broken toe in place as it heals.

·       Taping. A common treatment known as buddy taping involves taping the injured toe to the healthy toe next to it. It’s not always helpful, so ask your provider first. The provider can also show you how to tape the toe properly.

Children shouldn’t walk on the toe until they can put pressure on it without feeling a lot of pain. Also, attend follow-up visits if you have them. Your child’s provider will examine the toe to ensure it is healing properly. 

Broken toes may need six to eight weeks to heal, according to the American Academy of Orthopaedic Surgeons, so be patient. 

Call your child’s provider if your child has any of these symptoms as the toe heals: 

·       Fever or chills, which could be signs of an infection

·       Tingling or numbness in the toe

·       Pain or swelling that gets worse, not better

·       Red streaks appearing on the foot or toe

Can a Broken Toe Heal on Its Own?

Broken toes can heal on their own, but treatment helps ensure better outcomes. Left untreated, broken toes may heal crooked, your child could develop chronic foot pain or he or she may have problems walking. 

Broken Toe vs. Stress Fracture

Active children and children who play sports may think they have a broken toe when they actually have an overuse injury. Activities that involve repetitive motions, such as running, or place significant force on the feet, such as basketball, can cause stress fractures, a type of overuse injury in which small cracks or painful bruising develop in the bones.

The ball of the foot has two small bones called sesamoids located below the big toe joint. Overuse can lead to a sesamoid stress fracture, which can cause pain and swelling near the base of the big toe. A sports medicine specialist can diagnose and treat these stress fractures and help your child prevent another overuse injury.

If you’ve visited an urgent care or emergency room and your child has a confirmed fracture, bring your child’s X-rays to our walk-in Fracture Clinic for help. The clinic is located at 5700 Dallas Parkway in Frisco and open from 7:30 – 9:30 a.m., Monday through Friday. For suspected fractures, schedule an appointment by calling 469-515-7200. 

Waterproof Cast 101

Waterproof Cast 101

by | May 30, 2023 | Fractures

Casts are made of two layers — a soft inner layer and a hard outer layer. The inner layer of a waterproof cast uses a special type of lining that allows it to get wet when bathing, showering or swimming.

Does a waterproof cast have any risks?
Every time a waterproof cast gets wet, it needs to completely dry. If the skin inside the cast stays wet for a long period of time, it can become irritated. If your child develops a rash or burning sensation while in the cast, notify your clinic immediately.

Waterproof cast care

  • A waterproof cast needs to get wet daily.
  • After your cast gets wet, make sure all of the water exits the cast by moving your arm/leg around.
    • Your natural body heat will evaporate the rest of the water in the cast.
    • You may also use a hair dryer, on the cool setting, to finish the drying process in areas like the elbow crease or heel of the foot.
  • Following bathing and swimming, flush the inside and outside of the cast with a forceful stream of clean water only.
  • If the cast gets itchy, dirty or smelly, you may rinse mild soap through the cast and then thoroughly flush it with clean water.

What else should I know about caring for a child in a waterproof cast?

  • Follow directions and activity restrictions given by your provider.
  • See cast care patient education for more information.
  • You may swim in lakes and oceans with the waterproof cast, but it can be difficult to remove sand, dirt and other small particles from inside the cast. If particles are left in the cast, they can cause skin irritation and discomfort. Please be sure to flush the cast thoroughly with clean water until all particles are removed before allowing the cast to dry.

Learn more about our Fracture Clinic.

Six Ways to Prevent Toddler Fractures

Six Ways to Prevent Toddler Fractures

by | Feb 9, 2023 | Fractures

According to Gerad Montgomery M.S., F.N.P.-C. from our Fracture Clinic, toddlers are naturally at an increased risk for certain fractures and other injuries. This is because they are in a phase of rapid growth, very active and very unsteady when walking. Toddler’s bones are soft and will often break or buckle with seemingly harmless injuries. He tells us that many injuries that cause a sprain or strain in an adult will cause a fracture in a toddler. The good news, for patients like 22-month-old Kye, is that these injuries generally are stable and do not require casts or splints for very long, if at all.

Here are some common toddler injuries we see in our Fracture Clinic:

Toddler’s fracture is a small break in the bone of the lower leg usually caused by a simple fall or a twisting injury. A common way these injuries occur is when a child’s foot is caught on a playground slide while going down the slide with a parent.

Nursemaid’s elbow occurs with a sudden forceful pull on an outstretched arm. This may happen when someone picks up the child or swings him or her by the arms. With this problem, the child often refuses to use the arm and holds it in a flexed position.

Fingertip injuries occur in thousands of young children each year, and they typically wind up in an outpatient clinic or emergency room. These injuries often result from accidents with common items such as home and car doors, drawers or scissors.

Broken bones from falls and collisions occur when playing with larger, stronger and faster kids or on equipment that is not age-appropriate.

Lessons to Learn:

  • Do not pick up or tug on your child while holding only his or her hands or wrists; this can put stress on the elbow.
  • Do not swing your child around when holding only their hands or wrists.
  • Toddlers should use age-appropriate playground equipment and slides.
  • Toddlers should ride down a playground slide alone.
  • Watch your toddler closely when climbing or playing with bigger kids.
  • Doors, drawers and sharp objects are not toys and young children should not play with them.

As experts in managing fractures and other injuries in growing bones, we are here for you when you need us. Learn more about our Fracture Clinic

Top 10 Things to Know about Pediatric Fractures

Top 10 Things to Know about Pediatric Fractures

by | Oct 31, 2022 | Fractures

These are key messages from a lecture provided as part of a free, monthly education series offered for Medical Professionals. Gerad Montgomery, M.S.N., FNP-C, is a certified family nurse practitioner and director of the Scottish Rite for Children Orthopedics Fracture Clinic in Frisco, Texas.

Download the PDF.

Watch Top 10 Things to Know about Pediatric Fractures on-demand.

Alternatively, you can access the full pediatric fracture care lecture on our Medical Professionals playlist where he also addresses questions from the audience including these:

  • What are your thoughts on the use of X-rays or advanced imaging in an urgent care or outpatient setting before sending to a pediatric musculoskeletal expert?
  • Would you recommend putting in a hematoma block for pain control before referring to a specialist?
  • Do you have guidelines for return-to-sport or load management after fracture?
  • What do you tell parents that wonder if their child needs an X-ray?

#10 A Methodical Exam Is Your Best Tool 

Perform a methodical exam every time, the same way. It may not be easiest, but it is the best tool.

  • X-rays and history should augment a good step-by-step physical exam.
  • Age-appropriate exam may include the parent assisting to help maintain comfort.
  • Encourage pointing to the injured area with “one finger at one spot.”
  • Then, examine the contralateral side first.
  • Always examine the joint above and below.

#9 Don’t Miss Signs of a Non-accidental Trauma  

More than half of children who die from non-accidental trauma have a history of prior maltreatment. Know your resources and obligations. Listen closely to the story and vigilantly observe for signs and red flags such as:

  • Inconsistent history
  • Unwitnessed trauma
  • Fracture doesn’t match story (i.e., femur fracture in non-ambulatory child)
  • Multiple fractures in various stages of healing – skeletal survey
  • Skin stigmata – bruises, burns

#8 X-Ray Views Matter

Poor alignment during X-rays can cause you to miss a fracture. Despite the patient’s discomfort, it is important to insist on good alignment and at least two views.

Learning how to describe a fracture over the phone when you are discussing a referral. Terms to use include:

  • Open vs. closed
  • Proximal vs. distal
  • Angulated – apex volar vs. apex dorsal
  • Shortening
  • Displaced vs. non-displaced

# 7 Not All Fractures Require a Cast   

Don’t let the treatment be worse than the injury. In some cases, immobilization may not be necessary. Depending on the condition, an alternative to a cast, such as a boot or a splint, may provide appropriate immobilization and allow early motion and an easier option for treatment.

#6 Splints and Casts Are NOT Benign  

When a cast or splint is indicated, here are key messages for patient education to prevent complications like skin breakdown:

  • Elevate the extremity for the first three days after the splint/cast is applied.
  • Never place anything inside of the splint.
  • DO NOT attempt to remove and re-apply a splint without help from a health care provider.
  • Monitor for signs and symptoms of neurovascular compromise.
  • Teach them how to check this and what to do should an issue occur (cap refill, sensation changes, increasing pain, proper elevation)
  • DO NOT get your splint or cast wet. Call your health care provider immediately if it does.

#5 Pediatric Fracture Patterns

Know the pediatric bony anatomy and fracture patterns. Though complete fractures are possible with higher mechanism injuries, incomplete fractures are more common on the pediatric population.

An open physis may look to some like a fracture. Additionally, an open physis may also hide a fracture that you don’t want to miss. Any injury near the physis may benefit from an earlier referral to ensure no growth disturbance.

#4 Most Pediatric Fractures Can Be Managed Without Surgery   

The Pediatric Orthopaedic Society of North America (POSNA) states on its website, “The standard of care for the treatment of pediatric forearm fractures remains nonoperative treatment with closed reduction and casting. An acceptable functional outcome with closed treatment is the rule in a majority of fractures.”

Our pediatric fracture clinic sees hundreds of children with fractures each week. Very few of these children require operative care for their fractures. Staffed with pediatric-focused nurses, medical assistants and orthopedic cast technicians, our clinic also has full-time, certified child life specialists. They are experts at providing developmentally appropriate education and support before, during and after diagnosis, care and complex in-clinic procedures.

#3 Pediatric Bone Remodeling Is Remarkable   

Pediatric bone is structurally different than adult bone in the following ways:

  • Less dense/more porous
  • Increased elasticity
  • Tend to break in “patterns” (greenstick, torus/buckle, plastic deformation, complete, etc.)
  • Thick periosteum
  • Potential to remodel

These characteristics make remodeling “easy” in young patients. Fractures in these conditions have greater remodeling potential with:

  • Patient is younger in age
  • Fracture is closer to the physis
  • More growth remaining in the adjacent physis

Learn more about how Scottish Rite for Children is helping to define evidence-based care for treating clavicle fractures and how the outcomes in operative and nonoperative care are similar.

# 2 Not All Fractures Are an Emergency

Every fracture does not need to be treated in the emergency setting. This can save stress and use of expensive resources. A study of more than 200 cases has shown this can cause unnecessary anxiety and increased pain due to increased number of assessments before definitive care with pediatric orthopedic specialist.

Be familiar with your resources to manage and refer accordingly.

  • Safely immobilize with sling, boot or splint.
  • Provide crutches, when indicated

Educate the patient and family:

  • Pain control
  • Warning signs
  • Elevation
  • Immobilization and proper education
  • Appropriately timed referral to pediatric orthopedics

Examples of orthopedic emergencies that can’t wait include, but are not limited to:

  • Open fractures
  • Neurovascular concerns
  • Severe swelling
  • Severe clinical deformity
  • Slipped capital femoral epiphysis (SCFE)
  • Femur fractures
  • Pain uncontrolled with over-the-counter medications

#1 You Are Treating the Patient AND the Parents!

Majority of second opinions are requested to provide clarity, not necessarily a different treatment. Here are suggestions to optimize the conversations at the first visit:

  • Spend extra time with the family. This may reduce frustration and duration of subsequent visits.
  • Discuss expectations and timelines for both treatment and healing.
  • Map out what to expect at subsequent visits.
  • Identify and address questions or complications right away. Pediatric injuries are not always straightforward, and you must be able to explain things in ways that parents will understand and trust your diagnosis and treatment.

Montgomery emphasized the important role that patient and family education plays in pediatric fracture care. “If that family leaves your office and the family does not feel comfortable with your plan, you’ve lost,” he says. “We spend a lot of time with families to make them comfortable.”

Top 10 Things to Know about Pediatric Fractures

Top 10 Things to Know about Pediatric Fractures

by | Oct 31, 2022 | Fractures

These are key messages from a lecture provided as part of a free, monthly education series offered for Medical Professionals. Gerad Montgomery, M.S.N., FNP-C, is a certified family nurse practitioner and director of the Scottish Rite for Children Orthopedics Fracture Clinic in Frisco, Texas.

Download the PDF.
 
Watch Top 10 Things to Know about Pediatric Fractures on-demand.
 
Alternatively, you can access the full pediatric fracture care lecture on our Medical Professionals playlist where he also addresses questions from the audience including these:

  • What are your thoughts on the use of X-rays or advanced imaging in an urgent care or outpatient setting before sending to a pediatric musculoskeletal expert?
  • Would you recommend putting in a hematoma block for pain control before referring to a specialist?
  • Do you have guidelines for return-to-sport or load management after fracture?
  • What do you tell parents that wonder if their child needs an X-ray?

#10 A Methodical Exam Is Your Best Tool 

Perform a methodical exam every time, the same way. It may not be easiest, but it is the best tool.

  • X-rays and history should augment a good step-by-step physical exam.
  • Age-appropriate exam may include the parent assisting to help maintain comfort.
  • Encourage pointing to the injured area with “one finger at one spot.”
  • Then, examine the contralateral side first.
  • Always examine the joint above and below.

#9 Don’t Miss Signs of a Non-accidental Trauma  

More than half of children who die from non-accidental trauma have a history of prior maltreatment. Know your resources and obligations. Listen closely to the story and vigilantly observe for signs and red flags such as:

  • Inconsistent history
  • Unwitnessed trauma
  • Fracture doesn’t match story (i.e., femur fracture in non-ambulatory child)
  • Multiple fractures in various stages of healing – skeletal survey
  • Skin stigmata – bruises, burns

#8 X-Ray Views Matter

Poor alignment during X-rays can cause you to miss a fracture. Despite the patient’s discomfort, it is important to insist on good alignment and at least two views.
 
Learning how to describe a fracture over the phone when you are discussing a referral. Terms to use include:

  • Open vs. closed
  • Proximal vs. distal
  • Angulated – apex volar vs. apex dorsal
  • Shortening
  • Displaced vs. non-displaced

# 7 Not All Fractures Require a Cast   

Don’t let the treatment be worse than the injury. In some cases, immobilization may not be necessary. Depending on the condition, an alternative to a cast, such as a boot or a splint, may provide appropriate immobilization and allow early motion and an easier option for treatment.

#6 Splints and Casts Are NOT Benign  

When a cast or splint is indicated, here are key messages for patient education to prevent complications like skin breakdown:

  • Elevate the extremity for the first three days after the splint/cast is applied.
  • Never place anything inside of the splint.
  • DO NOT attempt to remove and re-apply a splint without help from a health care provider.
  • Monitor for signs and symptoms of neurovascular compromise.
  • Teach them how to check this and what to do should an issue occur (cap refill, sensation changes, increasing pain, proper elevation)
  • DO NOT get your splint or cast wet. Call your health care provider immediately if it does.

#5 Pediatric Fracture Patterns

Know the pediatric bony anatomy and fracture patterns. Though complete fractures are possible with higher mechanism injuries, incomplete fractures are more common on the pediatric population.
 
An open physis may look to some like a fracture. Additionally, an open physis may also hide a fracture that you don’t want to miss. Any injury near the physis may benefit from an earlier referral to ensure no growth disturbance.

#4 Most Pediatric Fractures Can Be Managed Without Surgery   

The Pediatric Orthopaedic Society of North America (POSNA) states on its website, “The standard of care for the treatment of pediatric forearm fractures remains nonoperative treatment with closed reduction and casting. An acceptable functional outcome with closed treatment is the rule in a majority of fractures.”
 
Our pediatric fracture clinic sees hundreds of children with fractures each week. Very few of these children require operative care for their fractures. Staffed with pediatric-focused nurses, medical assistants and orthopedic cast technicians, our clinic also has full-time, certified child life specialists. They are experts at providing developmentally appropriate education and support before, during and after diagnosis, care and complex in-clinic procedures.

#3 Pediatric Bone Remodeling Is Remarkable    

Pediatric bone is structurally different than adult bone in the following ways:

  • Less dense/more porous
  • Increased elasticity
  • Tend to break in “patterns” (greenstick, torus/buckle, plastic deformation, complete, etc.)
  • Thick periosteum
  • Potential to remodel

These characteristics make remodeling “easy” in young patients. Fractures in these conditions have greater remodeling potential with:

  • Patient is younger in age
  • Fracture is closer to the physis
  • More growth remaining in the adjacent physis

Learn more about how Scottish Rite for Children is helping to define evidence-based care for treating clavicle fractures and how the outcomes in operative and nonoperative care are similar.

# 2 Not All Fractures Are an Emergency

Every fracture does not need to be treated in the emergency setting. This can save stress and use of expensive resources. A study of more than 200 cases has shown this can cause unnecessary anxiety and increased pain due to increased number of assessments before definitive care with pediatric orthopedic specialist.
 
Be familiar with your resources to manage and refer accordingly.

  • Safely immobilize with sling, boot or splint.
  • Provide crutches, when indicated

Educate the patient and family:

  • Pain control
  • Warning signs
  • Elevation
  • Immobilization and proper education
  • Appropriately timed referral to pediatric orthopedics

Examples of orthopedic emergencies that can’t wait include, but are not limited to:

  • Open fractures
  • Neurovascular concerns
  • Severe swelling
  • Severe clinical deformity
  • Slipped capital femoral epiphysis (SCFE)
  • Femur fractures
  • Pain uncontrolled with over-the-counter medications

#1 You Are Treating the Patient AND the Parents!

Majority of second opinions are requested to provide clarity, not necessarily a different treatment. Here are suggestions to optimize the conversations at the first visit:

  • Spend extra time with the family. This may reduce frustration and duration of subsequent visits.
  • Discuss expectations and timelines for both treatment and healing.
  • Map out what to expect at subsequent visits.
  • Identify and address questions or complications right away. Pediatric injuries are not always straightforward, and you must be able to explain things in ways that parents will understand and trust your diagnosis and treatment. 

Montgomery emphasized the important role that patient and family education plays in pediatric fracture care. “If that family leaves your office and the family does not feel comfortable with your plan, you’ve lost,” he says. “We spend a lot of time with families to make them comfortable.”

Wrist Complaints You Shouldn’t Ignore – Fracture Clinic Tips

Wrist Complaints You Shouldn’t Ignore – Fracture Clinic Tips

by | Aug 31, 2021 | Fractures

Falling onto an outstretched hand can often cause injuries to the ulna and/or radius, or the long bones in the arm. The most common injuries are called both bone forearm fractures (BBFA) or buckle fractures. Sometimes, the carpals, the smaller bones in the wrist, may be injured instead. When the hand is turned slightly inward during a fall, the scaphoid bone is most likely to be injured.

“In some cases, early X-rays of a painful wrist may not show an obvious fracture,” nurse practitioner in the Fracture Clinic Ray Kleposki, M.S.N., CPNP, says. “A detailed physical exam of the wrist is important to evaluate for a small fracture in the scaphoid or other bones.”

Scaphoid injuries tend to be slow to heal, so early intervention is important and can help to prevent future complications. Kleposki has helpful advice to parents about what to look for following a fall onto an outstretched hand. “If there is a concern for a scaphoid fracture, or if the wrist pain after a fall has not gotten better in more than a week, we recommend a specialized X-ray series to evaluate for a scaphoid fracture or other diagnosis,” Kleposki says.

Falling down and getting a few bruises comes naturally as kids play and learn new skills! Parents can rest easy knowing that experts at Scottish Rite for Children are here to help when a child breaks a bone or when a seemingly minor injury bothers a child longer than a few days.

Learn more about the multi-disciplinary care in our Fracture Clinic.