By Dr. Kelly A. Johnson, MD
Sprains, strains and fractures:
Now that spring is in the air and the days are longer, we are all spending more time outside enjoying physical activities. As expected, I always see an increase in injuries this time of year. Although injuries are common, many parents are unclear as to how to treat them and when medical intervention is needed. Also, the fear of something being “broken” can lead to inappropriate requests for x-rays before they are necessary.
Most injuries in children are minor and are a result of damage to soft tissues (muscle, connective tissue, tendons, and ligaments) and not bone. Swelling, bruising, and pain are not indicators of fractures only, but injuries of soft tissues as well.
If your child suffers an injury that causes an obvious deformity, or a bone has broken the skin, you need to proceed to nearest emergency room for immediate treatment. That also includes blue or cold fingers and toes. Your pediatrician or urgent care centers cannot treat complex fractures and dislocations. These usually require the attention of an orthopedic specialist and conscience sedation for pain. This also includes a head injury involving loss of consciousness or severe altered behavior. These are medical emergencies and emergency rooms are the appropriate places to treat these injuries
Otherwise, stay calm and remember the acronym RICE. It stands for rest, ice, compression, and elevate. Your also need to treat the pain with ibuprofen every 8 hours for 2-3 days, not Tylenol. Have your child stop physical activity immediately, don’t wait until the game is over if it’s a sporting event. If your child does not rest and protect the injury, it will not heal. Most sprains and strains take 1-2 weeks of rest to completely heal. Place ice for 10 minutes every 2 hours to the area that is painful and swollen. Icing for more than 10 minutes at a time can cause frost bite! Compressing the area with an ace wrap or splint can reduce swelling, just not so tight that skin turns pale or blue in color. Elevate the body part above the level of heart to decrease swelling and pain. RICE can safely be done for 24-48 hours. If pain and swelling is greatly improved after 2 days of RICE, a fracture is unlikely. After 48 hours, injuries should be evaluated by your doctor or an urgent care clinic if there is no improvement. X-rays may or may not be needed, but a doctor needs to evaluate the situation.
Less than 1% of x-rays taken at my urgent care clinic show bone fractures, so that means over 99% of children had needless x-ray exposure. There is an increased risk in cancer with increased exposure to x-rays. As parents, we need to keep this in mind and let a doctor’s guidance and not fear help you decide what treatment is best for your child.
If you have further questions, need an appointment or want to read previous newsletters, visit my website at www.pedihousecalls.com