New treatment for childhood broken bones?

Broken bones are common in childhood. Many children sustain injuries during play and sports, where bones are either broken or fractured.

One of the most terrifying experiences for both children and parents is when the broken bone actually breaks through the skin causing a puncture wound. In most cases, surgery is required to set the bone and reduce the chance of infection.

But a recent study, published in the Journal of Children’s Orthopaedics by a team at Johns Hopkins Children’s Center in Baltimore, has found that surgery may not be necessary for open bone fractures in the forearm or lower leg. In fact, researchers found that they can heal safely, without surgery. Researchers said that if a wound is less than a ½-inch in diameter and the tissue around the injury does not contain any impurities, then many kids can heal on their own.

“This is a great study,” says Dr. Andrea Kramer, a pediatric orthopedic surgeon at Advocate Children’s Hospital in Park Ridge, Ill. “While the sample in the study is small, if we can prove that we can safely treat children with grade one open fractures without surgery, it would be a big plus for kids and their parents.”

Dr. Kramer adds that avoiding surgery would avoid inherent risks that come with it, such as anesthesia or surgical infections. There could be less scaring and a faster recovery, he says. Health care costs could also be significantly reduced.

“As physicians, we would need to closely follow these kids post-surgery, to make sure they do not develop infections, but we are doing that anyway,” Dr. Kramer says.

The team at Johns Hopkins suggests that only simple, clean open breaks, which are very common in children, would be appropriate for treatment without surgery. Certainly not all open breaks would be candidates, researchers said. With only 40 participants in this study, a larger study is needed before this approach becomes commonplace.

“Not all pediatric fractures are created equal and our findings indicate that when it comes to simple, clean open breaks, which are very common in kids, a minimalistic ‘clean, set the bone and watch’ approach could be just as effective as more aggressive surgical treatment,” said Dr. Paul Sponseller, study senior investigator and director of pediatric orthopaedics at the Johns Hopkins Children’s Center, in a release.

“I would tell parents that every fracture is different,” Dr. Kramer says. “Parents need to trust their physicians to make good decisions about their child’s break.”