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Should Your Child See a Doctor?

Leg Injury

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Definition

  • Injuries to leg
  • Injuries to a bone, muscle, joint or ligament

Types of leg injuries

  • Fractures (broken bones)
  • Dislocations (bone out of joint)
  • Sprains — stretches and tears of ligaments
  • Strains — stretches and tears of muscles (e.g., pulled muscle)
  • Muscle overuse injuries from sports or exercise (e.g., shin splints of lower leg)
  • Muscle bruise from a direct blow (e.g., thigh muscles)
  • Bone bruise from a direct blow (e.g., hip)

Pain severity scale

  • MILD: doesn't interfere with normal activities
  • MODERATE: interferes with normal activities or awakens from sleep
  • SEVERE: excruciating pain, unable to do any normal activities, incapacitated by pain

When to Call Your Doctor for a Leg Injury

Call 911 now (your child may need an ambulance) if

  • Serious injury with multiple fractures
  • Major bleeding that can't be stopped

Call your doctor now (night or day) if

  • You think your child has a serious injury
  • Looks like a broken bone or dislocated joint
  • Large swelling
  • Skin beyond the injury is pale or blue
  • Skin is split open or gaping and may need stitches
  • Age under 1 year old
  • Bicycle spoke or washing machine wringer injury
  • Pain is SEVERE (and not improved after 2 hours of pain medicine)
  • Won't stand or walk
  • Has a limp when walking
  • Unable to move leg normally
  • Joint nearest the injury can't be moved fully (opened and closed)
  • Knee injury with a "snap" or "pop" felt at the time of impact

Call your doctor within 24 hours (between 9 a.m. and 4 p.m.) if

  • You think your child needs to be seen
  • Pain not improved after 3 days

Call your doctor during weekday office hours if

  • You have other questions or concerns
  • No tetanus shot in over 5 years for DIRTY cuts (over 10 years for CLEAN cuts)
  • Pain lasts over 2 weeks

Parent care at home if

  • Bruised muscle or bone from direct blow
  • Pain in muscle (probably from mild pulled muscle)
  • Pain around joint (probably from mild stretched ligament)

Home Care Advice for Minor Leg Injuries

  1. Treatment of Pulled Muscle, Bruised Muscle or Bruised Bone:
    • Reassurance: Bruised muscles or bones can be treated at home.
    • Pain: For pain relief, give acetaminophen every 4 hours OR ibuprofen every 6 hours as needed. (See dosage table). Ibuprofen is more effective for this type of pain.
    • Local Cold: For bruises or swelling, apply a cold pack or ice bag wrapped in a wet cloth to the area for 20 minutes per hour. Repeat for 4 consecutive hours. (Reason: reduce the bleeding and pain.)
    • Local Heat: After 48 hours apply a warm wet washcloth or heating pad for 10 minutes three times per day to help absorb the blood.
    • Rest: Rest the injured part as much as possible for 48 hours.
  2. Treatment of Mild Sprains (Stretched Ligaments) of Ankle or Knee:
    • First aid: immediate compression and ice to reduce bleeding, swelling, and pain.
    • Treat with R.I.C.E. (rest, ice, compression, and elevation) for the first 24 to 48 hours.
    • Apply compression with a snug, elastic bandage for 48 hours. Numbness, tingling, or increased pain means the bandage is too tight.
    • Apply a cold pack or ice bag wrapped in a wet cloth to the area for 20 minutes per hour. Repeat for 4 consecutive hours.
    • Give acetaminophen (e.g., Tylenol) or ibuprofen for pain relief. Continue for at least 48 hours.
    • Keep injured ankle or knee elevated and at rest for 24 hours.
    • After 24 hours, allow any activity that doesn't cause pain.
  3. Expected Course: Pain and swelling usually peak on day 2 or 3. Swelling is usually gone by 7 days. Pain may take 2 weeks to completely resolve.
  4. Call Your Doctor If:
    • Pain becomes severe
    • Pain is not improving after 3 days
    • Pain lasts over 2 weeks
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.

References

  1. AAP Section on Orthopedics. Management of pediatric trauma. Pediatrics. 2008;121(4):849-853.
  2. Brenner JS and the Council on Sports Medicine and Fitness. Overuse injuries, overtraining, and burnout in child and adolescent athletes. Pediatrics. 2007;119(6):1242-1246.
  3. Clark E, Plint A, Correll R, et al. A randomized, controlled trial of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma. Pediatrics. 2007;119:460-467.
  4. England SP and Sundberg S. Management of common pediatric fractures. Pediatr Clin North Am. 1996;43:991-1011.
  5. Giunta YP, Rocker JA. Sprains. Pediatr Rev. 2008;29(5):176-178.
  6. Huurman WW and Ginsburg GM. Musculoskeletal injury in children. Pediatr Rev. 1997;18(12):429-440.
  7. Koutures CG. An overview of overuse injuries. Contemp Pediatr. 2001;18(11):43-70.
  8. Lilly K, McCambridge TM. Running injuries. Contemp Pediatr. 2008;25(7):46-64.
  9. Mankin KP and Zimbler S Foot and ankle injuries: Solving the diagnostic dilemmas. Contemp Pediatr. 1996;13(3):25-45.
  10. Patel DR, Janiski C. Ankle sprains in young athletes. Contemp Pediatr. 2005;22(12):65-82.

Disclaimer

This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 1/4/2010

Last Revised: 12/16/2009 10:10:58 AM

Version Year: 2010

Copyright 1994-2010 Barton D. Schmitt, M.D.

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