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Fractures and Osteogenesis Imperfecta

What to Do When a Fracture Occurs

First, do not blame yourself, your spouse, or whoever was with your child when the fracture occurred. The sooner you can accept fractures as a part of your child's physical makeup, and not as the world's greatest crisis, the better off you all will be. Fractures will occur no matter how careful you are. Often, you will be shocked that a bone doesn't break when you thought that a fracture was inevitable. Any adult who has lived a lifetime with osteogenesis imperfecta will tell you that it is much better to live life to its fullest, take a few risks, and possibly suffer through some fractures than to exist in a padded world trying to avoid broken bones.
At first, you will want to take your baby to the orthopedic surgeon whenever a fracture occurs. As you become more familiar with your child's condition, the physician may suggest that you care for the fracture at home.
To ease the initial discomfort after a bone fractures, you can administer pain medicine as prescribed by your physician. Then, carefully transport your child to the doctor. If it is very uncomfortable for your baby to be moved, consider devising a stretcher out of a piece of plywood padded with foam or a pillow. Drive slowly to avoid potholes and jarring.

Casting Fractures

Fractures are usually treated by applying a cast. Many doctors choose to only cast fractures that are causing a great deal of discomfort for the child or that need the immobilization that a cast provides to ensure proper healing. There is a concern that application of a cast causes decreased mobility and increases the likelihood of osteoporosis (or increased bone brittleness). This can lead to even more fractures and cause the bone to become more brittle. For this reason, many physicians limit casting for children with osteogenesis imperfecta as much as possible. Often, they will apply a splint and wrap the area with an elastic bandage.
The type of cast most frequently applied to the legs is called a hip spica cast. This is applied around the waist and over one or both legs, leaving the crotch area exposed. Since this type of cast makes toileting or diapering very uncomfortable for the child, some parents choose to gently slide a thin, absorbent hospital pad under the child and remove it as it gets soiled. Arms are cast less frequently than legs in young children because the weight of the cast causes difficulty, and the bone near the armpit could receive too much stress from the movement and weight of the cast. Often, the doctor will simply apply a sling to a fractured arm, wrapping it firmly against the body for support. When this type of sling is used, watch for color changes that may indicate problems with circulation.
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