Bone Fractures: From Break to Cast Removal

No matter how bone fractures develop, it’s essential to a growing child that it heals properly.


There seems to be no limit to the ways that kids find to break their bones, from common ways like launching off a trampoline or slipping on the monkey bars to more mundane things like tripping over an untied shoelace or falling out of bed. No matter how a bone is broken, it’s essential to a growing child that it heals properly. Fortunately, bones are natural healers. At the location of a bone fracture, a bone produces new cells and tiny blood vessels that help rebuild itself. These cells cover both ends of the broken part of the bone and close up the break until it’s as good as new. Of course, to ensure proper healing, it’s vital that the broken bone is casted correctly. That’s where the Fracture Clinic at Primary Children’s Hospital comes into play.

Casting Call

Run by pediatric orthopedic specialists, including orthopedic surgeons, attending physicians, medical assistants, and X-ray technicians, the Fracture Clinic  operates every Wednesday from 8:30 a.m.– 6:00 p.m. and is open to patients that have been previously evaluated and/or referred by a primary care provider. Our clinic puts more casts on children and teens than any other facility in the Intermountain West. During the winter months, our clinic sees about 60 to 80 patients every Wednesday. Not surprisingly, that number jumps to between 140 and 160 patients in the summer, when kids are the most active.

Children with broken bones are referred to the Fracture Clinic in such large numbers because, as specialists at Primary Children’s Hospital, we understand the nuances of treating injured children. We recognize that bone fractures in a child can be very different from a fracture in the same location in an adult. When a child breaks a bone, there needs to be special consideration of how the injury may affect the growth plate. At the Fracture Clinic, we do everything possible to ensure that casts are put on smoothly and without causing any pain or damage to growth plates.

Casting 101

The process starts with a thorough evaluation, usually done by a primary care provider before we see the patient. A proper evaluation is key to correctly treat and cast the injury. Some telltale signs that a bone is broken include:

  • A snap or a grinding noise was heard during the injury.
  • There’s swelling, bruising, or tenderness around the injured part.
  • It’s painful for your child to move it, touch it, press on it, or bear weight on it.
  • The injured part looks deformed. With severe breaks, the broken bone might poke through the skin.

Once we’ve determined that a bone is indeed broken, the cast does not go on immediately. Instead, patients must usually wait for about a week after the break before being casted to allow time for swelling to go down. The actual casting takes about 10 minutes and can be uncomfortable for some patients, but no pain medication is needed during the process.

A child or teen with a broken bone will typically wear the cast for three to six weeks, depending on the age of the patient and the location of the broken bone. The Fracture Clinic is also at the forefront of advances in materials used for casts. We constantly test new and improved materials to help make the experience as convenient as possible. The waterproof lining in our casts help to ensure that a broken bone causes as little disruption as possible to a child’s active lifestyle.

Cast Care Tips

  • Keep cast as clean as possible.
  • Rough edges may be filed down with an emery board.
  • Do not insert objects inside of cast—they may break down the skin and cause an infection.
  • Do not use powders, oils, or oil-based lotions in the cast.
  • Do not engage in vigorous activity involving the casted extremity.
  • Do not expose the inside of the cast to dirt, sand, gravel, or wood chips.
  • Your cast should be rinsed out after swimming or bathing with a mild soap and water mix.
  • The cast must be allowed to thoroughly dry before getting wet again. If the cast is not dry after 1 to 3 hours, take a hair dryer, place it on the cool setting and dry it out, tapping the cast with a spoon as the air blows.

Cast Off

When it’s time for the cast to come off, the Fracture Clinic takes another X-ray to make sure the bone has healed properly. The cast is then cut off using a saw with an oscillating blade that does not cut or tear skin. Once the cast is off, the injured area might look strange at first. The skin may be pale, dry, or flaky. Body hair might look darker and the body part itself might look smaller because muscle may have been lost during healing. This is only temporary and no cause for worry. In some cases, we might recommend that the patient do special exercises to improve strength and flexibility. Patients may also be counseled to avoid certain activities, such as hanging from monkey bars, for a month or so after the cast comes off in order to avoid any chance of re-breaking the same bone.