Jan 13, 2014

Young Athlete Back in the Game: Lessons on Broken Bones Questions to ask your doctor to help ensure that a broken bone has not shifted inside a seemingly secure cast.

Pediatric Orthopedic Surgeon Dr. Christine Ho examines a young patient’s arm.

After the cast is off, and your child has returned to a normal routine, have you ever wondered if your child’s bone is really mended? In some cases, the answer is no.

When Matthew Walston was six years old, the rough-and-tumble boy broke his elbow falling from the top of a fence he was climbing. His mother, Tamii Whitworth, says that after being treated near his home in East Texas, Matthew had to wear a cast from his shoulder past his elbow for seven weeks. Physical therapy appointments three times a week helped Matthew regain a good range of motion, and before long, the fearless six-year-old was back to his old, happy-go-lucky self.


Questions For Parents to Ask

  1. How soon after my child’s bone is set will there be a follow-up exam?
  2. How do you know that the bone is stable inside the cast and hasn’t shifted?
  3. Under what circumstances would my child need surgery to assist with proper healing?
  4. At what point is an X-ray taken to confirm that everything has healed correctly?

Now, flash forward seven years, and 13-year-old Matthew is in junior high. Playing football for his school team, he starts to experience pain in the same elbow that was broken. "At first we thought he was having growing pains," says Tamii. "Then the pain increased, and he had some swelling in his arm."

After X-rays and a CT scan in East Texas, Matthew was referred to Christine Ho, M.D., attending Pediatric Orthopedic Surgeon  at Children’s Medical Center and Associate Professor of Orthopedic Surgery at UT Southwestern.

A Diagnosis and Treatment Plan

Both Matthew’s mom and stepdad work in the health care field, so when they learned that Matthew was being referred to Children’s, they immediately were fearful of the complexity of Matthew's diagnosis. Thankfully, Dr. Ho was there to ease their concerns.

"Dr. Ho quickly put us at ease and calmed our fears," says Tamii. "She explained that when a broken bone is set inside a cast, it will occasionally shift, causing the break to not completely heal." What Matthew had was a lateral condyle fracture that went on to become an undiagnosed nonunion (failure of the broken bone to completely heal).

"If a  broken bone inside a cast shifts, it’s generally within the first few weeks of the break, and at that time the bone needs to be stabilized," says Dr. Ho. "Depending on the age of the patient, the type of fracture and if the growth plate is open, the fracture may need to be treated with temporary pins that can be removed in the clinic once there is enough healing, and let the remainder of healing happen without pins."

In Matthew’s case, he was 13 years old and needed a permanent plate and screws. The plate lies over the bone, and the screws secure it on each side of the break. "The motion in Matthew’s elbow was good, so we didn’t want to risk losing it," says Dr. Ho. "To avoid the possibility of compromising that motion, we placed the plate and screws to keep the alignment of the bone the same. To try to get the bone to heal, since it had not healed after 7 years, we scraped the bone back around the nonunion and with a bone graft, packed the open area."

After surgery, Matthew spent one night in the hospital under observation for pain control, and wore an arm cast – this time for just two weeks. "After surgery he had some pain while in the hospital, but only needed pain medicine for about a week," says Tamii. The bone graft taken from Matthew's hip caused some soreness and this is what Matthew remembers most.

Back in the Game

On Sept. 23, four month after his surgery, Matthew was cleared by the doctors at Children's to play football and participate in all the training that goes with it. "He's had a great season, and played several different positions for the Hooks Junior High football team," says Tamii.  "He also has a really cool scar to show his friends."

Mom's Advice to Parents

If your child complains about pain, especially after a past injury in or near that area, have it checked out!