Leg Fractures
Fractures or broken bones are common childhood injuries due to increased activity levels and growing bones.
Most fractures heal well and cause no ongoing/long-term complications.
Most common childhood fractures are wrists, arms, elbows and ankles which usually occur after a fall.
Broken bones heal quickly in children. They usually have to wear a cast for 4-8 weeks. In this time, the body has laid down a thick layer of new bone around the fracture to keep it secure and in place.
Treatment
After the cast is removed
Pain Relief
Returning to Normal Activities
Treatment
If a child breaks a bone in their lower limb (leg), they will likely have a cast placed on their leg to support it whilst the bone heals.
Where your child’s fracture is will determine what is used to support the bone’s healing:
- A full cast will be used if the fracture is either above or below the knee
Read: How to Care for your Plaster Cast - A backslab (a partial cast held in place by bandages) allows swelling to reduce before changing to a full cast
- An aircast boot (an ankle boot) allows distributed weight bearing whilst supporting bone healing. This can be removed to allow gentle range of movement exercises and cleaning.
Your clinician will explain which treatment is best for your child’s fracture. If your child is in a full cast or backslab they will usually be non-weight bearing until this is removed. Your clinician in trauma clinic will explain what your child should and shouldn’t do, and whether to put weight on the leg.
After the cast is removed
The healing process continues after the cast has been removed. New layers of bone continue to be laid and ‘remodelling’ phase commences.
It is normal, once the cast has been removed, to experience some changes in your leg such as;
- The joints feeling stiff
- The leg being slightly smaller than the other side
- The fracture site being prone to swelling
- The skin being dry, flaky and sometimes having changes in hair growth.
As the leg muscles have not been used for a while they will be weaker initially.
Once the cast is removed it is normal for your child to complain of aches and discomfort when using that leg more. These should be easily managed with adequate pain relief.
Pain Relief
It is normal to experience mild pain and some children will require pain relief like Paracetamol or anti-inflammatories such as ibuprofen.
See NHS 111 Wales guidelines here on pain relief.
You can also seek advice from your local pharmacy.
Returning to Normal Activities
Initially after your cast is removed, try to avoid any high impact activities such as jumping, running or climbing.
Start off with slow walks and increase the distance and speed at a steady pace and it is not causing increased pain or discomfort.
Your child might initially walk with a limp or foot turned out slightly, this is common and will usually correct itself when your child returns to normal routine activities, walking and play within a couple of months.
The leg will return to normal size and walking should return to normal within a short space of time.
Exercises
Range of movement exercises
Your child should be encouraged to do gentle range of movement (ROM) exercises as soon as the cast is removed. They should also be encouraged to walk and start to put equal weight through both legs.
Try to encourage your child to start using their legs normally and to get their joints moving again and strengthening the muscles that have been immobilised within the cast.
Below are some movements to encourage with younger and older children once the cast has been removed to reduce stiffness and encourage weight bearing to strengthen their muscles.
Exercises for Younger Children
Gentle range of movement activities are nice to do in the bath initially, as the warm water helps to ease stiffness.
Try to encourage the following activities with your child:
- Spell out their name using their ankle
- Bend and straighten the knee
- If they are too young to do this, you can gently move the joints through their usual movements for them.
Weight bear through the injured leg
For younger children, try the following:
- Sit on the floor with your child on your lap.
- Put their feet flat on the floor in front of them and encourage them to reach forward to pick up toys from the floor.
- Encourage standing from sitting on your lap or a small bench to play in standing
- Cruising from side to side and keeping both toes facing forwards whilst playing
Exercises for Older Children
As with younger children is it important to encourage gentle range of movement exercises as soon as the cast is removed to reduce stiffness.
Try to encourage the following activities with your child:
- Stand in front of a mirror with feet hip width apart.
- Stand tall and make sure your weight is equal on both legs.
- The mirror will help you to see this better.
- Spell out their name using their ankle
- Bend and straighten the knee
Once you have been advised it is safe to do so, progress to the following exercises:
- March on the spot
- Step ups
- Mini squat
Weight bearing exercise
- Stand tall with your feet touching holding on to something solid for balance support.
- Then standing on your injured leg.
Leg Lifts
- Stand tall with your feet touching holding on to something solid for balance support.
- Then standing on your injured leg.
Bridging
- Lie on the floor with your legs stretched out in front.
- Bend your legs at the knees with the soles of your feet resting on the floor
- Using your feet to take the weight slowly lift your bottom off the floor
Walking
- Walking is also a great form of exercise.
- Slowly increase the distance and speed as your child feels able within their pain limits.
- Make sure that they’re not doing too much one day, and needing a few days to recover.
- Make sure that they pace themselves and increase their distance slowly each day.
If you have any concerns or queries about this information please contact Dolphin Outpatients on 02921 847577.
If your child does not have an appointment arranged with physio and symptoms continue or are not improving gradually, then you can self-refer your child to the Paediatric Physiotherapy Outpatient Department by telephoning the our referral line on 02921 836908.
