Open Hand Fracture (Child)  

Your child has a hand fracture. This means that one or more bones in the hand are broken. An open fracture means that the bone goes through the skin or there is a wound in the skin that goes as deep as the fractured bone. Because of this, there is a risk of infection to the skin or bone. An open fracture of the hand will be painful and swollen and may be bloody.

To find out how severe the fracture is, X-rays or other imaging tests are done. The bone is then moved back into place, if necessary. The skin wound is closed with stitches or surgical glue. You’ll be told how to care for the wound. Depending on the cause of the injury and your child’s vaccination status, a tetanus shot may be given.

To protect the injured hand and hold the bones in place while they heal, a splint or a cast will be used. Often this will extend to above the elbow. Open hand fractures often require surgery.

Medicines

• Your child’s healthcare provider may prescribe an oral antibiotic to prevent infection. Follow the provider’s instructions for giving this medicine to your child. Do not stop giving your child this medicine until you have finished the prescribed course.
• Give your child pain medicines as directed by the doctor. If no pain medicines were prescribed, you may use over-the-counter medicine as directed by the provider.
• Always talk with your child’s provider before using these medicines if your child has chronic liver or kidney disease or ever had a stomach ulcer or GI bleeding.
• Do not give ibuprofen to a child younger than 6 months old. 
• Do not give your child aspirin.  

 General care

• Keep the hand elevated to reduce pain and swelling. This is most important during the first 48 hours after injury. As often as possible, have your child sit or lie down and place pillows under the child’s arm until the hand is raised above the level of the heart.
• Apply a cold pack to the injury to control swelling. Hold the pack on the injured area for no more than 15 to 20 minutes. Do this every 1 to 2 hours for the first 24 to 48 hours. Continue this as needed to ease swelling and pain. To make an ice pack, put ice cubes in a plastic bag that seals at the top. Wrap the bag in a clean, thin towel or cloth. Never put ice or an ice pack directly on the skin. The ice pack can be put right on the cast, bandage, or splint. As the ice melts, be careful that the cast or splint doesn’t get wet. Care for the splint or cast as you’ve been instructed. Do not put any powders or lotions inside the splint or cast. Keep your child from sticking objects into the splint or cast.
• Keep a splint or cast completely dry at all times. When your child bathes, the splint or cast should be covered with 2 plastic bags. Place 1 bag outside of the other. Tape each bag with duct tape at the top end.  Younger children may be hurt when removing duct tape. For younger children, put a rubber band around each bag at the top end. Water can still leak in. So it's best to keep the cast or splint away from water. If a fiberglass splint or cast gets wet, dry it with a hair dryer on a cool setting.

Follow-up care

Follow up with your child’s healthcare provider, or as advised. Follow-up X-rays may be needed to see how the bone is healing. If your child was given a splint, it may be changed to a cast at the follow-up visit. If you were referred to a specialist, make that appointment promptly.

If X-rays were taken, you will be told of any new findings that may affect your child’s care.

Once the fracture has properly healed and the splint or cast is removed (4 to 8 weeks), physical therapy may be prescribed by your child’s health care provider to bring back proper function and strength to the fractured wrist.

Special note to parents

Healthcare providers are trained to recognize injuries like this one in young children as a sign of possible abuse. Several healthcare providers may ask questions about how your child was injured. Healthcare providers are required by law to ask you these questions. This is done for protection of the child. Please try to be patient and not get upset.

When to seek medical advice

Call your child's healthcare provider right away if any of these occur:

• Fever, as directed by the healthcare provider or:
  • Your child is younger than 12 weeks and has a fever of 100.4°F (38°C) or higher. Your baby may need to be seen by his or her healthcare provider.
  • Your child has repeated fevers above 104°F (40°C) at any age.
  • Your child is younger than 2 years old and the fever continues for more than 24 hours. Or your child is 2 years old and older and the fever continues for more than 3 days.
• Wet or soft splint or cast
• Splint or cast is too tight or too loose
• Increasing swelling or pain
• Fingers on injured hand become cold, blue, numb, or tingly
• Redness, warmth, swelling, or drainage from the wound
• Splint or cast has a bad smell