Bone Grafting in Children

Bone Grafting in Children

Bone grafting is a surgical procedure to repair damaged bones or joints with another piece of bone or a man-made substitute (bone graft). There are three basic types of bone grafts. Your child may have a graft from:

• A piece of his or her own bone (autograft). In many cases, the graft is taken from the top of the hipbone (iliac crest). The graft can also be taken from your child’s rib, leg, or other bones.
• A healthy donor (allograft). These grafts are frozen and stored at a tissue bank for future use.
• A man-made substance similar to bone. These types of grafts do not stimulate new bone growth. They serve as a bridge that new bone can grow into (osteoconduction).

Your child may need a bone graft to repair a bone that broke into many pieces (complex fracture) and is difficult to treat. Bone grafting may also be done to fill a bone defect that a child develops or is born with. A bone graft supports your child’s bone and also stimulates healing. A bone graft may also be used to fuse two bones together. This is often done in spinal surgery. Bone grafting may also be part of treatment for cancer or for severe injuries that require reconstruction of the head and face.

Tell your child’s health care provider about:

• Any allergies your child has.
• All medicines your child is taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems your child or members of your family have had with anesthetic medicines.
• Any blood or bone disorders your child has.
• Any surgeries your child has had.
• Any medical conditions your child has.
• Any recent infections your child has had, including skin infections.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Delayed healing.
• Graft failure, requiring additional surgery.

What happens before the procedure?

Staying hydrated

Follow instructions from your child’s health care provider about hydration, which may include:

• Up to 2 hours before the procedure – your child may continue to drink clear liquids, such as water or clear fruit juice.

Eating and drinking restrictions

Follow instructions from your child’s health care provider about eating and drinking, which may include:

• 8 hours before the procedure – have your child stop eating foods.
• 6 hours before the procedure – have your child stop drinking formula or milk.
• 4 hours before the procedure – stop giving your child breast milk.
• 2 hours before the procedure – have your child stop drinking clear liquids.

Medicines

• Ask your child’s health care provider about:
  • Changing or stopping your child’s regular medicines. This is especially important if your child is taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your child’s blood. Do notgive these medicines before the procedure if your child’s health care provider instructs you not to.
• Your child may be given antibiotic medicine to help prevent infection.

General instructions

• Ask your child’s health care provider how your child’s surgical site will be marked or identified.
• Plan to take your child home from the hospital or clinic.
• If your child will be going home right after the procedure, plan to be with your child for 24 hours.

What happens during the procedure?

• To reduce your child’s risk of infection:
  • Your child’s health care team will wash or sanitize their hands.
  • Your child’s skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV tube will be inserted into one of your child’s veins.
• Your child will be given one or more of the following:
  • A medicine to help your child relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine to make your child fall asleep (general anesthetic).
• If your child is having an autograft:
  • An incision will be made over the autograft site. Bone tissue will be removed.
  • The incision will be closed with stitches (sutures) or staples.
• The surgeon will make an incision to open up the area over the bone where the graft will be attached.
• The bone graft will be placed around the bone. It may be held in place with pins, plates, or screws.
• The surgeon will close the incision with sutures or staples.
• A bandage (dressing) will be placed over the incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your child’s blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines your child was given have worn off.
• Your child will be given pain medicine as needed.
• Your child may be sent home with a cast, splint, or brace.
• Your child’s IV tube will be removed, and the insertion site will be checked for bleeding.
• If your child is of driving age, do notlet your child drive for 24 hours if he or she was given a sedative.

Care After Bone Grafting in Children

What can I expect after the procedure?

After the procedure, it is common for your child to have:

• Pain.
• Bruising.
• Swelling.
• Stiffness.

Follow these instructions at home:

If your child has a splint or brace:

• Have your child wear the splint or brace as told by your child’s health care provider. Remove it only as told by your child’s health care provider.
• Loosen the splint or brace if your child’s fingers or toes tingle, become numb, or turn cold and blue.
• Do notlet your child’s splint or brace get wet if it is not waterproof.
• Keep the splint or brace clean.

If your child has a cast:

• Do notallow your child to stick anything inside the cast to scratch the skin. Doing that increases your child’s risk of infection.
• Check the skin around the cast every day. Tell your child’s health care provider about any concerns.
• You may put lotion on dry skin around the edges of the cast. Do notput lotion on the skin underneath the cast.
• Do notlet your child’s cast get wet if it is not waterproof.
• Keep the cast clean.

Bathing

• Do nothave your child take baths, swim, or use a hot tub until his or her health care provider approves. Ask your child’s health care provider if your child can take showers. Your child may only be allowed to take sponge baths for bathing.
• If your child’s cast, splint, or brace is not waterproof, cover it with a watertight covering when he or she takes a bath or a shower.
• Keep your child’s bandage (dressing) dry until his or her health care provider says it can be removed.

Incision care

• Follow instructions from your child’s health care provider about how to take care of your child’s incision. Make sure you:
  • Wash your hands with soap and water before you change your child’s bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your child’s dressing as told by your child’s health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your child’s health care provider tells you to do that.

Check your child’s incision area every day for signs of infection. Check for:

• More redness, swelling, or pain.
• More fluid or blood.
• Warmth.
• Pus or a bad smell.

Managing pain, stiffness, and swelling

• If directed, apply ice to the injured area:
  • If your child has a removable splint or brace, remove it as told by your child’s health care provider.
  • Put ice in a plastic bag.
  • Place a towel between your child’s skin and the bag or between the cast and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Have your child gently move his or her fingers or toes often to avoid stiffness and to lessen swelling.

Have your child raise (elevate) the injured area above the level of his or her heart while he or she is sitting or lying down.

Driving

• If your child is of driving age:
  • Do notlet your child drive while taking prescription pain medicine
  • Do notlet your child drive for 24 hours if he or she was given a medicine to help him or her relax (sedative).
  • Ask your child’s health care provider when it is safe to drive if your child has a cast or splint on his or her arm, hand, foot, or leg.

General instructions

• Have your child return to his or her normal activities as told by his or her health care provider. Ask your child’s health care provider what activities are safe for your child.
• Do notlet your child use heavy machinery while taking prescription pain medicine.
• Do notallow your child to put pressure on any part of the cast or splint until it is fully hardened. This may take several hours.
• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

• Your child has chills or a fever.
• Your child’s pain medicine is not helping.
• Your child has more redness, swelling, or pain around the incision.
• Your child has more fluid or blood coming from the incision.
• Your child’s incision feels warm to the touch.
• Your child has pus or a bad smell coming from the incision.
• Your child’s cast, splint, or brace:
  • Is too loose or too tight.
  • Gets damaged.

Get help right away if:

• Your child has pain or swelling that gets worse.
• The back of your child’s lower leg (calf) gets red, warm, painful, or swollen.
• Your child has chest pain.
• Your child has trouble breathing.
• Your child has numbness or tingling.
• Your child who is younger than 3 months has a temperature of 100°F (38°C) or higher.