Child Orthopedics

Frequently Asked Questions

Our 11-year old daughter was out skateboarding when she broke her leg (thigh). She has an unstable comminuted fracture. Can you tell us what that means?

Comminuted refers to bones that are broken into two or more pieces. Sometimes the bone is shattered into many tiny little pieces. Unstable refers to the fact that the bone fragments can shift and cause poor bone alignment while healing.

Sometimes this type of fracture requires surgery to pin or wire it in place while it heals. In other cases, the arm or leg is placed in a cast. Usually, the patient is not allowed to put any weight through the foot. The idea is to prevent shortening or other deformity of the bone. The hope is for good healing without the need for further surgery.

For children, there is always a concern that growth might be slowed on one side (the fractured side) compared to the other. This is most likely to be a problem if the bone near the growth plate has been fractured. Your surgeon will make every effort to prevent disturbances in growth, alignment problems, or deformities.

Surgery is often needed in unstable fractures. When the femur (thigh) is involved, it may be necessary to insert a long rod called a nail down into the shaft of the bone.

Most likely your daughter will not be allowed to put any weight on that leg until healing occurs. In some cases, the type of nail used might allow up to 40 per cent of body weight even when it's a comminuted fracture. Your surgeon will let you know what your daughter can and cannot do over the next few weeks until healing takes place.

Karl E. Rathjen, M.D., et al. Stainless Steel Flexible Intramedullary Fixation of Unstable Femoral Shaft Fractures in Children. In Journal of Pediatric Orthopaedics. June 2007. Vol. 27. No. 4. Pp. 432-441.

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