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My daughter broke her leg and we were told to go a hospital if there were any problems with pain

Q: While we were on vacation, my 11-year-old stepdaughter fell and broke her leg. The surgeon who saw her put a cast on the leg but told us to get to a hospital right away if there are any signs of problems. Now we are on the road heading home and she's complaining "it hurts, it hurts" I don't know what to do. Stop or press one? We are still six to eight hours away from home.

A: Situations like this one can be difficult to judge. Some of the decision may depend on your daughter's temperament (prone to dramatic complaining versus rarely complains), the type of fracture (simple, compound, open, closed, one bone or both bones in the lower leg), and how long ago the leg was casted (recently or sometime ago).

The biggest concern with something like this is the risk and potential for a condition known as compartment syndrome. Compartment syndrome describes a condition in which fluid (swelling or blood) builds up inside one or more of the individual compartments of the leg. Traumatic injuries, especially bone fractures that puncture the soft tissues are a common cause of compartment syndrome.

There is no way to know for sure if she is developing this condition. Some of the symptoms may include pain way out of proportion to the injury, pain that isn't relieved by medications, and increased use of pain medication (e.g., narcotics) are early signs of a potential problem.

Has she been given any pain relieving medication? Does she need a change in position? Anyone experiencing numbness or partial paralysis of the toes, foot, or leg must be seen by a medical professional immediately. In cases like this with the risk of compartment syndrome, it's better to err on the side of caution and at least have someone check her over. It may be an extra hour in the return trip but a lifetime of disability if compartment syndrome causes death of the tissue and loss of limb.

Reference: Joe Eric Gordon, MD, and June c. O'Donnell, MPH. Tibia Fractures: What Should Be Fixed? In Journal of Pediatric Orthopaedics. June 2012. Supplement. Vol. 32. No. 1. S.52-S61.

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