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ORIF of a Hip Fracture in Children

AMBULATORY CARE:

What you need to know about open reduction and internal fixation (ORIF) of a hip fracture:

ORIF of a hip fracture is surgery to fix a broken bone in your child's hip. Open reduction means that the bone is moved back into the right place with surgery. Internal fixation means that hardware (such as screws, rods, or pins) is used to hold the broken bones together.

Internal Fixation Device

How to prepare your child for ORIF:

  • Your child's surgeon will tell you how to prepare. He or she may tell you not to let your child eat or drink anything after midnight before surgery.
  • Tell your child's surgeon about all the medicines your child currently takes. He or she will tell you if you need to stop any of your child's medicines for surgery, and when to stop. He or she will tell you which medicines to give your child on the day of surgery.
  • Tell your child's healthcare provider about all of your child's allergies. Tell him or her if your child has had an allergic reaction to anesthesia, antibiotics, or contrast liquid.
  • Your child may need blood tests, an x-ray, bone scan, CT, MRI, or ultrasound before his or her surgery. These tests may show what kind of fracture your child has so healthcare providers can better plan his or her care. Do not let your child enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if your child has any metal in or on his or her body.

What will happen during your child's ORIF:

  • Your child will be given general anesthesia to keep him or her asleep during surgery. An incision will be made on your child's hip. Blood that has collected around the fracture may be drained. This will decrease pressure and help blood flow to the bone and the 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 for tests. The broken bone will be moved back into place and fixed in place with hardware.

What will happen after your child's ORIF:

  • Pain medicine may be given. Do not wait until your child's pain is severe before you ask for more medicine.
  • Your child may be placed in a hip spica cast. This cast goes around your child's stomach and extends down his or her hip and thigh. Instead of a hip spica cast, your child may have a cast only on the injured leg. Your child may have a bar between his or her legs that is attached to the cast. This bar holds his or her bones and joint in place so they can heal.
    Hip Spica Cast
  • Healthcare providers will work with you and your child so that leg movements will slowly increase over time. Your child may be in a cast for up to 8 weeks. Then he or she may begin physical therapy. Ask healthcare providers if and when your child may need to have his or her hardware removed.

Risks of ORIF for a hip fracture:

  • Surgery may damage the nerves in your child's leg. The hip may not heal correctly, or it may fracture again. Your child's bones may not grow back together, and he or she may need more surgery. He or she may need surgery to replace his or her hip with artificial parts. Depending on what part of the hip was broken, your child's bones may not grow correctly. Your child may get a life-threatening blood clot.
  • Blood flow to the head of the femur could be poor, and the bone could begin to die. This 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 or her femur may close early. These changes could cause one of your child's legs to be shorter than the other, and cause trouble walking.

Call your local emergency number (911 in the US) if:

  • Your child feels lightheaded, short of breath, and has chest pain.
  • Your child coughs up blood.

Seek care immediately if:

  • Your child tells you that his or her leg feels tender or painful. It may feel warm to the touch, and look swollen and red.
  • Your child has a cast and his or her toes become swollen, cold, or numb. His or her toes may also look pale or blue.
  • Your child has blood or pus leaking from the surgery wound.

Call your child's doctor or surgeon if:

  • Your child has pain that does not go away with medicine or gets worse.
  • Your child has a fever.
  • Your child has stomach pain or is vomiting.
  • You have questions or concerns about your child's condition or care.

Medicines:

  • Prescription pain medicine may be given. Ask your child's healthcare provider how to give this medicine safely. Some prescription pain medicines contain acetaminophen. Do not give your child other medicines that contain acetaminophen without talking to a healthcare provider. Too much acetaminophen may cause liver damage. Prescription pain medicine may cause constipation. Ask your child's healthcare provider how to prevent or treat constipation.
  • Do not give aspirin to children under 18 years of age. Your child could develop Reye syndrome if he takes aspirin. Reye syndrome can cause life-threatening brain and liver damage. Check your child's medicine labels for aspirin, salicylates, or oil of wintergreen.
  • Give your child's medicine as directed. Contact your child's healthcare provider if you think the medicine is not working as expected. Tell him or her if your child is allergic to any medicine. Keep a current list of the medicines, vitamins, and herbs your child takes. Include the amounts, and when, how, and why they are taken. Bring the list or the medicines in their containers to follow-up visits. Carry your child's medicine list with you in case of an emergency.

Wound and cast care:

Ask how to care for your child's wound. If your child has a hip spica cast, he or she will be taught how to use the bathroom and take a bath. You will learn how to help him or her do these activities and how to clean the cast and keep it dry. You will also learn how to help your child move and get dressed.

Hip Spica Cast

Activity:

Your child may need to use crutches or a cane. He or she may only bear weight on the toes of his or her injured leg when he or she first starts to walk. If your child is in a spica cast, he or she may need to use a wheelchair.

Physical therapy:

Your child may need physical therapy after his or her cast is removed. A physical therapist teaches your child exercises to help improve movement and strength, and to decrease pain.

For 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/

Follow up with your child's doctor or surgeon as directed:

Your child may need to return to have his or her stitches, staples, or cast removed. He or she may also need x-rays or other imaging tests to check for bone healing. Write down your questions so you remember to ask them during your visits.

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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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