When Your Child Needs Orthopaedic Surgery
Your child is having bone or joint surgery. The healthcare provider who performs this surgery is called an orthopaedic surgeon. This sheet can help you prepare your child and learn what to expect.
Two ways of performing orthopaedic surgery
Depending on why your child needs surgery, the procedure may be done one of two ways. Your healthcare provider will talk with you about your child’s surgery and the approach that will be used:
Open surgery is the traditional method of performing surgery. It is usually done through one incision. This incision is large enough for the surgeon to have a direct view of the area to be operated on.
Arthroscopic surgery (also called arthroscopy) is done through several smaller incisions. An arthroscope (a tube with a tiny video camera and a light) is inserted through one incision. This gives the surgeon a clear view of the area being operated on. Surgical tools are then put through other small incisions to perform the surgery.
Helping your child prepare
The idea of having surgery can be scary. You can help your child have a more positive experience during surgery by preparing him or her in advance. How you do this depends on your child’s needs. Many children’s hospitals have a child-life specialist who can help you and your child prepare. Here are some tips:
Explain the surgery to your child in brief and simple terms. Younger children have shorter attention spans, so do this shortly before the surgery. Older children can be given more time to understand the surgery in advance.
Point out the body part that will be operated on.
Explain to your child that he or she will be “asleep” during surgery. Reassure your child that he or she won’t feel the surgery being done.
Allow your child to ask questions.
Use play when appropriate. This can involve role-playing with a child’s favorite toy or object. It may help older children to see drawings of what will be done during surgery.
Help your child pick his or her “comfort object” to bring to the hospital. This can be any small item, such as a toy, stuffed animal, or blanket. Your child will be able to keep the item until surgery begins.
The weeks before surgery
You will be given specific instructions to help your child prepare for surgery. Carefully follow any instructions given to you by your child’s surgeon. Below are 2 instructions that are common to most surgeries:
Tell your child’s healthcare provider what medicines your child takes. This includes over-the-counter medicines, herbs, and supplements. Your child may need to stop taking certain kinds of medicines before the surgery. This will help to prevent bleeding and other problems during and after the surgery.
Follow any directions your child is given for not eating or drinking before surgery.
The day of surgery
Here is what to expect right before surgery:
Arrive at the hospital on time. You will be asked to fill out certain forms.
Your child will be provided a gown to change into.
A provider called an anesthesiologist or nurse anesthetist will meet with you. He or she will discuss the medicines that will help your child sleep through the surgery. Be sure to ask any questions you have.
You may be asked by several people to confirm which part of the body is being operated on. This is routine and is for your child’s safety. The body part may also be marked with a pen.
Your child will be given an intravenous (IV) line. This gives your child fluids and medicines. Depending on the age of your child, the IV line may be put into the arm or the hand. The IV may be started after your child is asleep.
During the surgery
Here is what to expect during surgery:
Your child will be given general anesthesia. This is medicine that puts your child into a deep sleep.
A soft tube called a catheter may be placed into your child’s bladder. This helps drain urine during and right after the surgery.
The surgeon will perform the surgery using the method that has been discussed with you.
Recovering in the hospital
Here is what to expect after surgery:
After surgery, your child will be taken to the recovery room. This is also called the post-anesthesia care unit, or PACU. Here, monitors will be attached to your child. These monitors watch over your child’s breathing, blood pressure, and pulse.
Your child will be given pain medicine to stay comfortable.
The urinary catheter will likely be removed shortly after surgery. The IV line might stay in place for a few days.
In some cases, surgery is done with your child as an outpatient (the child goes home the same day). In other cases, your child needs to stay one or more days in the hospital. If your child stays overnight, he or she may be moved to a regular hospital room. Ask whether you can stay with your child.
Recovering at home
Here is what to expect once home after surgery:
Give your child prescribed medicines as instructed. Pain control after surgery is important to help with healing, so give pain medicines on schedule.
Schedule a follow-up visit with the surgeon after surgery.
Being active helps your child heal. But too much activity can harm healing incisions. Follow any activity instructions you are given.
If your child needs physical therapy during recovery, this may be started soon after surgery.
Follow any other instructions you are given for your child’s recovery.
Call your child’s healthcare provider
Contact the healthcare provider if your child has any of the following after surgery:
Fever (see Fever and children, below)
A seizure caused by the fever
Increase in pain or swelling at an incision site
Unexpected drainage from an incision
Increased redness around an incision
Bleeding from an incision
Fever and children
Always use a digital thermometer to check your child’s temperature. Never use a mercury thermometer.
For infants and toddlers, be sure to use a rectal thermometer correctly. A rectal thermometer may accidentally poke a hole in (perforate) the rectum. It may also pass on germs from the stool. Always follow the product maker’s directions for proper use. If you don’t feel comfortable taking a rectal temperature, use another method. When you talk to your child’s healthcare provider, tell him or her which method you used to take your child’s temperature.
Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old.
Infant under 3 months old:
Ask your child’s healthcare provider how you should take the temperature.
Rectal or forehead (temporal artery) temperature of 100.4°F (38°C) or higher, or as directed by the provider
Armpit temperature of 99°F (37.2°C) or higher, or as directed by the provider
Child age 3 to 36 months:
Rectal, forehead, or ear temperature of 102°F (38.9°C) or higher, or as directed by the provider
Armpit (axillary) temperature of 101°F (38.3°C) or higher, or as directed by the provider
Child of any age:
Repeated temperature of 104°F (40°C) or higher, or as directed by the provider
Fever that lasts more than 24 hours in a child under 2 years old. Or a fever that lasts for 3 days in a child 2 years or older.
If your child has a cast or splint
Call your child’s healthcare provider if:
The casted body part tingles or feels numb.
The cast feels too tight or too loose.
A rash develops under the cast or splint.
Fingers or toes swell, feel very cold, or turn blue or gray.
The cast or splint cracks or has rough edges that hurt.
The cast gets wet.
January 28, 2018
Bass, Pat F. III, MD, MPH,Joseph, Thomas N., MD,Turley, Ray, BSN, MSN