We need some help as soon as possible. Our eight-year-old daughter has a broken arm (forearm to be exact). The on-call surgeon at the hospital recommended surgery but our pediatrician took a look at the X-rays and said a cast would be enough. If surgery is needed, it can be delayed without additional problems. We love and trust our pediatrician but the orthopedic specialist’s idea of surgery rings in our ears. Is the expert always right? Ack! I hate making decisions like this when it involves the kids!

There is a clinical trend toward more aggressive treatment for upper extremity (arm) fractures in children despite research evidence that less aggressive treatment is just as effective. Large studies that compared operative versus nonoperative treatments have concluded that less aggressive care is safe and effective.

More aggressive treatment is not to be recommended routinely. Case studies published describing individual patients with specific concerns are more likely to advise the use of aggressive treatment. Perhaps there are some reasons why the surgeon advised surgery for your daughter that must be considered.

Some surgeons may take the more aggressive approach because of improved techniques and advancing technology making it easier to perform these procedures. It’s also possible that surgeons are influenced by advertising of newer surgical techniques. Patients may even be the source of pressure to be surgically aggressive if they believe “more is better.”

In terms of research evidence, the majority of comparative studies and case series recommend conservative (less aggressive) care for upper extremity fractures in children. As your pediatrician suggested, fewer diagnostic tests, less medicine, no surgery (or slower time to surgery) with less invasive surgical procedures is advised.

The bottom line is that you want an evidence-based, least invasive treatment plan that is safe and effective for your daughter. With this in mind and the information presented here, talk with your pediatrician about your concerns. You always have the option of getting a third opinion with an orthopedic surgeon recommended by your pediatrician.