Open Reduction And Internal Fixation Of A Hip Fracture In Children

What is open reduction and internal fixation of a hip fracture?

• Open reduction and internal fixation of a hip fracture is surgery that is done to repair a broken hip. This surgery is also called ORIF. The femur is the long bone in the thigh that attaches to the hip joint. A hip fracture is a break in the top part of the femur. The top of the femur has a round area called the head of the femur. The head of the femur fits into the acetabulum, which is a cup shaped hollow area in the pelvis. The femur may fracture (break) at any area, including at or below the head of the femur, or along the growth plate. The acetabulum may also break. When the bone is fractured, it may also move out of place (dislocate).
  
  
• Your child may have broken his hip in a car crash, while playing sports, or by falling from a high place. Having a bone infection or disease, such as cancer or osteopenia, increases the risk of hip fracture. Reduction means that caregivers move the bone back into the right place. When caregivers do this without surgery, it is called closed reduction. When a surgical opening is made, it is called open reduction. Internal fixation means that hardware (such as rods or pins) is used to hold the broken bone together. After surgery, one or both of your child's legs will be in a cast until the bone heals. ORIF surgery may help your child's hip fracture heal, so that he can return to doing activities that he enjoys.

Why does my child need open reduction and internal fixation surgery?

ORIF surgery may be done if your child's bones are dislocated, and cannot be moved back into place using closed reduction. ORIF surgery may be needed if your child's broken bone is sticking out of his skin. If the fracture has damaged blood vessels (such as veins or arteries), ORIF of the femur or acetabulum fracture may be needed.

What happens during my child's open reduction and internal fixation surgery?

• Your child will be given medicine called general anesthesia to keep him asleep during surgery. An incision (cut) will be made through the skin and muscle over the bone fracture. A tool will be used to spread the muscle so that caregivers can see the broken bone. Blood that has collected around the fracture may be drained. This will decrease pressure and help blood flow to the bone and area around it. The femur head may be reshaped to help better fit the bone into place. If a disease caused the fracture, bone samples may be taken and sent to the lab for tests. The broken bone will be moved back into place.
  
  
• Hardware, such as metal screws, rods, or pins, will be put through your child's bone. The hardware is put in to hold the bone in the correct place. X-rays may be used during surgery to check the hardware placement. Your child's hip will be moved by caregivers after surgery to see that it is moving as it should.

What happens after my child's open reduction and internal fixation surgery?

• Your child may be placed in a hip spica cast. This cast goes around your child's stomach and extends down his hip and thigh. Instead of a hip spica cast, your child may have a cast only on his injured leg. Your child may have a bar between his legs attached to his cast. This may hold his bones and joint in place so they can heal. If your child cannot move his leg, caregivers may move it for him, allowing his hip to flex.
  
  
• Caregivers will work with you and your child so that his leg movements will slowly increase over time. Increasing his leg movement will help his bones and the surgery area heal. Your child may be in a cast for up to eight weeks, after which he may begin physical therapy. Your child may need to have his hardware, such as screws, removed after surgery. Ask caregivers if and when your child may need to have his hardware removed.

How do I care for my child after his open reduction and internal fixation surgery?

• Activity: If your child is in a hip spica cast, he may need to use a wheelchair. If your child has a cast on one leg, he may need to use crutches. Your child may not be able to return to his usual activities for a few months after surgery. He may need to wait until his bone has healed completely before playing sports. Ask your child's caregiver to explain what activities your child can do as his hip is healing. Ask caregivers when your child may return to school.
  
  
• Cast care: Ask caregivers how to help your child bathe and use the bathroom. Ask caregivers for more information about how to take care of your child's cast.
  
  
• Medicine: Your child will be given medicine to decrease pain. Tell caregivers if your child's pain does not go away or comes back quickly after taking the pain medicine. Pain medicine can have unwanted side effects. Tell a caregiver if your child has trouble breathing, is very sleepy, or has an upset stomach. Tell a caregiver if your child is allergic to any medicine.

What are the risks of open reduction and internal fixation of a hip fracture?

• After ORIF, your child may get an infection in the area where the surgery was done or in the hip bone. The fracture or surgery may damage the nerves in his leg. After surgery, your child's hip may not heal correctly, or it may fracture again. His bones may not grow back together, and he may need more surgery. He may need surgery to replace his hip with man-made parts (hip replacement). Depending on what part of the hip was broken, your child's bones may not grow correctly. Your child may get a blood clot in his leg. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in his body. The blood clot may break loose and travel to your child's lungs. A blood clot in the lungs can cause chest pain and trouble breathing. This problem can be life-threatening.
  
  
• A condition called avascular necrosis may develop at the head of the femur. This condition occurs when blood flow to the head of the femur is poor, and the bone begins to die. This condition can cause pain, swelling, trouble moving the hip, and changes to the shape of the femur. Surgery may be needed to treat this condition. Hardware placed during ORIF may move into the joint area, causing problems with bone growth. After ORIF, the angle of your child's hip bones may change, or the growth plate of his femur may close early. These changes cause one of your child's legs to be shorter than the other, and cause trouble walking.
  
  
• If your child does not have ORIF, his bone fracture may not heal. His bones may not grow back together correctly. Without surgery, bleeding inside the hip may lead to avascular necrosis. Your child may have nerve damage in his leg or have chronic (long-term) pain. Your child's legs may not grow evenly, and he may have lifelong problems with walking and moving his hip. If you have questions or concerns about your child's fracture, surgery, care, or risks, talk to his caregiver.

Where can I find more information?

• American Academy of Orthopaedic Surgeons
  6300 North River Road
  Rosemont , IL 60018-4262
  Phone: 1- 847 - 823-7186
  Web Address: http://www.aaos.org/
  

When should I call my child's caregiver?

Call your child's caregiver if:

• Your child has a fever.
  
  
• Your child has blood or pus leaking from the fracture or surgery wound (cut).

When should I seek immediate help?

Seek care immediately or call 911 if:

• Your child has chest pain or trouble breathing that gets worse over time.
  
  
• Your child has a cast and his toes become swollen, cold, or numb (lose feeling). His toes may also look pale (light in color), or blue.
  
  
• Your child has pain that does not go away with medicine or is getting worse.
  
  
• Your child tells you that his leg feels tender or painful. It may feel warm to the touch, and look swollen and red.
  
  
• Your child feels lightheaded, has trouble breathing, or he faints.
  
  
• Your child coughs up blood, has new, sudden chest pain, or has pain when he breathes or coughs.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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