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ORIF of an Arm Fracture in Children

AMBULATORY CARE:

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

ORIF of an arm fracture is surgery to fix a broken arm bone. Open reduction means the bones are moved back into the correct position. Internal fixation means plates, screws, pins, or wires will be used to hold the bones in place while they heal.

Internal Fixation Device

How to prepare your child for ORIF:

  • Your child's surgeon will tell you how to prepare your child for surgery. He or she may tell you not to let your child eat or drink anything after midnight on the day of surgery.
  • Tell your child's surgeon about any medicines your child is taking. He or she will tell you if your child should stop any medicine for surgery, and when to stop. He or she will tell you which medicines your child should take or not take on the day of surgery.
  • Your child may need to have blood and urine tests, and arm x-rays.

What will happen during ORIF:

  • Your child may be given general anesthesia to keep him or her asleep and free from pain during surgery. He or she may instead get regional anesthesia to numb the surgery area. Your child will be awake with regional anesthesia, but he or she should not feel pain. An incision will be made on or around your child's arm fracture. Your child's surgeon will use plates, screws, pins, or wires to put the broken pieces back together. Damaged blood vessels and nerves will also be fixed.
  • X-rays may be taken to see if the bones are in the correct position. The wound will be closed with stitches or medical tape and covered with bandages.

What your child should expect after ORIF:

Your child will be taken to a room to rest until he or she is fully awake. Healthcare providers will monitor him or her closely for any problems. Do not let your child get out of bed until his or her healthcare provider says it is okay. When healthcare providers see that your child is okay, he or she may be able to go home.

  • A cast or splint may be placed to help prevent movement so the bones can heal.
  • Medicines may be given to prevent or relieve pain or nausea.

Risks of ORIF for an arm fracture:

Your child's arm may become stiff, numb, or weak. The hardware may loosen and move out of place. The broken arm may not heal properly. Your child may not be able to move the arm the way he or she did before the injury. Your child's broken arm may not grow as long as the other arm. Your child may develop compartment syndrome (increased pressure in his or her arm). This can damage muscles and tissue. Your child may develop a life-threatening blood clot.

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

  • Your child has chest pain, a fast heartbeat, trouble breathing, or has fainted.

Seek care immediately if:

  • Blood soaks through your child's bandage.
  • Your child's cast or splint breaks or gets damaged.
  • Your child's stitches or staples come apart.
  • Your child has more swelling in his or her fingers.
  • Your child's fingers look pale or blue, feel numb, or tingle.

Call your child's doctor or surgeon if:

  • Your child tells you that the cast feels too tight.
  • Your child has a fever.
  • Your child's cast gets wet.
  • Your child's cast or splint breaks or begins to smell.
  • Your child's wound is red, swollen, or draining pus.
  • Your child's pain does not get better, even after he or she takes pain medicine.
  • You have questions or concerns about your child's condition or care.

Medicines:

Your child may need any of the following:

  • 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 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.
  • Antibiotics help fight or prevent an infection caused by bacteria.
  • 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.

Care for your child:

  • Limit activity. Your child will not be able to lift or move heavy objects after surgery. Ask your child's healthcare provider about the best activities for your child.
  • Elevate the arm. This will help relieve pain and swelling. Keep the arm above the level of your child's heart as often as possible. Prop the arm on pillows or blankets to keep it elevated comfortably.
    Elevate Arm
  • Apply ice to the surgery area. Ice helps decrease swelling and pain. Ice may also help prevent tissue damage. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel and place it on your child's arm, cast, or splint for 15 to 20 minutes every hour or as directed.
    Ice and Elevation
  • Ask when your child can bathe. When your child is allowed to bathe, cover the cast with 2 plastic bags. Tape the bags to his or her skin to keep the water out. Keep the cast out of the water so it does not get wet. If your child does not have a cast, carefully wash the surgery wound with soap and water. Dry the area and put on new, clean bandages as directed. Change the bandages when they get wet or dirty.

Cast or splint care:

  • Check the skin around your child's cast or splint every day. Apply lotion on any red or sore areas.
  • Do not let your child push down or lean on any part of the cast or splint, because it may break.
  • Do not let your child scratch the skin under the cast with any sharp or pointed object.
  • If your child's splint is too tight, gently loosen it so that his or her fingers are comfortable.
  • Have your child wiggle his or her fingers each day. This will help relieve swelling.

Take your child to physical therapy, if directed:

A physical therapist can teach your child exercises to help improve movement and decrease pain. Physical therapy can also help improve strength and decrease your child's risk for loss of function.

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

Your child will need to return to have the surgery wound checked and stitches or staples removed. 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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