If your child has had a fracture of a bone in their leg, they will have a cast to support and protect the bone while the fracture heals. The cast may be:
- a full cast
- a partial cast held in place with bandages – this is called a backslab.
It is important to care for your child’s leg and cast correctly after you leave hospital.
This fact sheet provides information on what to do once your child has been treated in hospital for a leg fracture. If you think your child has a fracture and you are looking for first aid advice, see our fact sheet Fractures (broken bones).
Care at home
Fractures are painful. Although immobilising the leg with a cast will help to reduce the pain, additional pain relief (e.g. paracetamol) is often needed. Give the pain relief medication regularly for the first few days, following the directions on the packet, or as directed by the doctor.
Elevate the leg
During the first one to two days, it is important for your child to rest and elevate their leg to minimise swelling. Raise your child’s leg on pillows when they are sitting or lying down. Encourage your child to move their toes frequently.
Skin care
Itching under the cast is common. Make sure your child avoids scratching inside the cast as this may damage the skin and cause infection. Do not let them push any object inside the cast (e.g. don’t allow them to use a ruler to scratch inside the cast). While it may be tempting to
remove a backslab for brief periods, it is recommended that you leave it in place.
Never cut or attempt to modify the cast or bandage.
You can help relieve itch by using a hair-dryer to blow cold air into the cast (do not use warm or hot air as this can burn the skin or warp the cast). Antihistamines may be useful for reducing the itch. Talk to your local pharmacist about a suitable antihistamine medication to use.
Cast care
If your child has a plaster cast, it is important to keep the cast clean and dry. For showering or bathing, seal the cast in a plastic bag with tape or a rubber band. Never allow your child to immerse the cast in water, even if it is in a plastic bag. For more information, see our fact sheet
Plaster cast care.
Even though fibreglass casts are waterproof, you need to make sure the padding underneath stays dry. If your child has a fibreglass cast, treat it as though it is a plaster cast and avoid getting it wet.
Moving about
Children are generally not allowed to put any weight on their fractured leg for walking, and must keep the foot off the ground. Older children may use crutches if it is safe to do so. See our fact sheet
Crutches.
Young children cannot manage crutches safely but may be able to use a walking frame. A wheelchair or pusher will be needed where crutches or a walking frame are difficult, and for longer distances.
If your child is allowed to put some weight on the leg, they will need to wear a specialised shoe over their cast. This is important to protect the cast and also to reduce the risk of falling.
When to see a doctor
Severe pain and swelling, change in the colour of the toes (white or blue), numbness or pins and needles, and inability to move the toes are signs that the leg hasn’t been elevated for long enough or your child’s cast may be too tight. If any of these signs occur, rest and elevate the leg
for 30 minutes. After elevating the leg for 30 minutes, take your child to the hospital emergency department immediately if:
- the toes remain very swollen
- the toes remain white or blue
- your child complains of pins and needles or numbness in the toes
- your child is not be able to move their toes, or complains of pain when you move them
- your child has severe pain that is not relieved by the recommended medication at the recommended dose.
Take your child to your GP or local hospital if:
- the cast is cracked, soft, loose or tight, or has rough edges that hurt
- you are worried that an object has been pushed inside the cast
- there is a bad smell or ooze coming from the cast
- your child is in increasing pain.
Follow-up
Your child’s doctor will tell you when your child should have a follow-up X-ray and appointment. The cast does not need to be removed to have the X-ray.
The cast will be able to be removed after the fracture has healed.
After the cast is removed
After the cast is removed, the skin may be dry, flaky or even smelly. Sometimes the skin appears red with small raised bumps. The hair on the skin may appear darker and thicker than normal. Over time, the appearance of the leg will return to normal.
- Wash the leg in warm soapy water. A soft flannel may be used, but avoid scrubbing the skin as this may cause it to bleed. Apply a gentle, non-perfumed moisturising lotion after bathing. It may take several days of gentle washing to remove all of the dead skin.
- Sometimes there is swelling once the cast is removed. Elevate the leg when resting (as shown above). Gentle foot exercises (moving the foot up, down and in circles) will also be helpful. If swelling is severe, limit your child’s physical activity, and rest and elevate the leg.
- Because the leg muscles have not been used while the leg has been in the cast, they will be weak initially. The leg will appear thinner, and the ankle or knee may be stiff. Your child’s leg will gradually return to the normal size and strength with regular use.
Your doctor will advise whether your child has any restrictions on walking, and they may need to keep using crutches, a walking frame or wheelchair for some time.
Your child may be anxious about putting weight through the leg. It is normal for them to limp at first, or walk with the leg held stiff or out-turned. This will improve with time, and most children will regain full use of their leg through their usual activities and play within a few months.
Encouragement helps to build their confidence and enables them to return to regular activities sooner. However, some children will require physiotherapy. Your child’s doctor will advise if this is needed.
High-impact, contact sports should be avoided for a minimum of four to six weeks after removal of the cast. Ask the doctor if you are not sure if your child is ready.
Key points to remember
- It is important to care for your child’s leg and cast correctly after you leave hospital. Always keep plaster casts clean and dry.
- Your child should elevate their leg for the first two days after the injury.
- Ensure your child avoids scratching inside the cast and do not let them push any object inside the cast.
- Seek urgent medical attention if after elevating the leg for 30 minutes your child still shows signs that the cast is too tight.
- After the cast comes off, your child’s leg may be weak and stiff, but normal use of the leg should return within a few months.
For more information
Common questions our doctors are asked
Will my child’s leg be more likely to break again after
having a fractured leg?
If the fractured bone has fully healed in the correct
position and alignment, then there is no residual weakness of the bone. It may
take some time for the muscles to regain their strength, but once this occurs,
your child will return to their normal strength and ability.
Do the follow-up appointments need to be at the hospital
where my child was originally treated?
No – you can have your follow-up appointments at a local
hospital or medical centre that is equipped to manage fractures. Your doctor
will be able to help you find an appropriate place for a follow-up appointment.
Why does my child only have a partial cast?
Not
all leg fractures require a full cast. If the fracture is minor, your child may
only require a backslab. Sometimes a backslab is used while doctors are waiting
for swelling of the leg to go down, and then a full cast will be put on your
child’s leg.
Developed by The Royal Children's Hospital and the Victorian Paediatric Orthopaedic Network. We acknowledge the input of RCH consumers and carers.
Reviewed November 2018.
This information is awaiting routine review. Please always seek the most recent advice from a registered and practising clinician.
Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit
www.rchfoundation.org.au.