Open Toe Fracture (Child)

A toe fracture is a broken toe bone. With an open fracture, a broken bone is exposed by a break in the skin. Because of this, there is a risk of infection to the skin or bone. An open fracture will be painful, swollen, and bruised. It may also be bloody.

To check the extent of the fracture, X-rays or other imaging tests are often done. The bone may then be moved back into place. The skin wound may then be closed, possibly with stitches) or surgical skin glue. To protect the injured toe and hold the bone in place while it heals, the injured toe may be taped to the toe beside it. (This is called “buddy taping.”) The child will likely be given a special shoe or boot to wear.

If the toenail has been significantly injured, it may be surgically removed or allowed to fall off. It often takes up to 12 months for a toenail to grow back. You likely will be asked about your child's vaccinations. He or she may need a tetanus shot if the wound is deep or dirty, or if your child's vaccine history is unclear. If the injury is severe enough, surgery may be needed. This is done by an orthopedic surgeon. This is a surgeon who specializes in treating bone, muscle, joint, and tendon problems.

Home care

  • The doctor may prescribe an oral antibiotic to prevent infection. Follow the doctor’s instructions for giving this medicine to your child. Don't stop giving your child this medicine until you have finished the prescribed course.

  • Give your child pain medicines as directed by the doctor. Don't give your child aspirin unless told to by a doctor.

  • Follow specific instructions given by your child's healthcare provider for the care of the injured toe and foot.

  • If your child is not given a special shoe or boot, use a shoe that protects the toe but does not put pressure on the injured toe. Your child should be careful not to bump the toe when not wearing a shoe, since another injury could make the fracture worse. If given crutches, your child should not put full weight on the injured foot until he or she can do so without pain, or until told to do so by his or her healthcare provider.

  • Keep the child's foot raised (elevated) to reduce pain and swelling. This is most important during the first 48 hours after injury. As often as possible, have the child sit or lie down and place pillows under the child’s leg until the foot is raised above the level of the heart. For infants or toddlers, lay the child down and place pillows under the leg until the injury is raised above the level of the heart. Be sure the pillows don't move near the face of the infant or toddler. Never leave the child unsupervised.

  • Apply a cold pack to the injury to help control swelling. To make a cold pack, put ice cubes in a plastic bag that seals at the top. Wrap the bag in a clean, thin towel or cloth. As the ice melts, be careful that the shoe or boot, or any cloth or paper tape doesn’t get wet. Don't place the cold pack right on the skin, as this can cause damage. 

  • Ice the injured area for up to 20 minutes every 1 to 2 hours the first day. Continue this 3 to 4 times a day for the next 2 days, then as needed. It may help to make a game of using the ice. However, if your child objects, don't force your child to use the ice. 

  • Keep the shoe or boot dry. Unless told otherwise, it can be removed for bathing. Keep your child from sticking objects into the shoe or boot.

  • If buddy tape was applied and it becomes wet or dirty, change it. You can replace it with paper, plastic, or cloth tape. Cloth tape and paper tape must be kept dry. Keep the buddy tape in place, as directed by the child's healthcare provider.

Follow-up care

Follow up with the child's healthcare provider, or as advised. Follow-up X-rays may be needed to see how the bone is healing. If your child was given a splint, it may be changed to a cast at the follow-up visit. If you were referred to a specialist, make that appointment promptly.

Special note to parents

Healthcare providers are trained to recognize injuries like this one in young children as a sign of possible abuse. Several healthcare providers may ask questions about how your child was injured. Healthcare providers are required by law to ask you these questions. This is done for protection of the child. Please try to be patient and not take offense.

When to get medical advice

Call your child's healthcare provider if any of these occur:

  • Wet shoe or boot

  • Increasing swelling or pain  (nonverbal infants may indicate pain with crying that can't be soothed)

  • Injured toe, nearby toes, or the foot becomes cold, blue, numb, burning, or tingly

  • Redness, warmth, swelling, or drainage from the wound, or a bad odor from the shoe or boot

  • In infants, fussiness or crying that can't be soothed

  • Fever (see "Fever and children," below)

  • Chills

Call 911

Call 911 if your child has:

  • Trouble breathing

  • Confusion

  • Trouble awakening or is very drowsy

  • Fainting or loss of consciousness

  • Rapid heart rate

  • Seizure

  • Stiff neck

Fever and children

Use a digital thermometer to check your child’s temperature. Don’t use a mercury thermometer. There are different kinds and uses of digital thermometers. They include:

  • Rectal. For children younger than 3 years, a rectal temperature is the most accurate.

  • Forehead (temporal). This works for children age 3 months and older. If a child under 3 months old has signs of illness, this can be used for a first pass. The provider may want to confirm with a rectal temperature.

  • Ear (tympanic). Ear temperatures are accurate after 6 months of age, but not before.

  • Armpit (axillary). This is the least reliable but may be used for a first pass to check a child of any age with signs of illness. The provider may want to confirm with a rectal temperature.

  • Mouth (oral). Don’t use a thermometer in your child’s mouth until he or she is at least 4 years old.

Use the rectal thermometer with care. Follow the product maker’s directions for correct use. Insert it gently. Label it and make sure it’s not used in the mouth. It may pass on germs from the stool. If you don’t feel OK using a rectal thermometer, ask the healthcare provider what type to use instead. When you talk with any healthcare provider about your child’s fever, tell him or her which type you used.

Below are guidelines to know if your young child has a fever. Your child’s healthcare provider may give you different numbers for your child. Follow your provider’s specific instructions.

Fever readings for a baby under 3 months old:

  • First, ask your child’s healthcare provider how you should take the temperature.

  • Rectal or forehead: 100.4°F (38°C) or higher

  • Armpit: 99°F (37.2°C) or higher

Fever readings for a child age 3 months to 36 months (3 years):

  • Rectal, forehead, or ear: 102°F (38.9°C) or higher

  • Armpit: 101°F (38.3°C) or higher

Call the healthcare provider in these cases:

  • Repeated temperature of 104°F (40°C) or higher in a child of any age

  • Fever of 100.4°F (38°C) or higher in baby younger than 3 months

  • Fever that lasts more than 24 hours in a child under age 2

  • Fever that lasts for 3 days in a child age 2 or older

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