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AIBU - Cast off after 15 days includes X-ray pic

(13 Posts)
BathshebaKnickerStickers Thu 21-Mar-19 18:19:50

15 days ago my daughter broke her radius and had a buckle ulna fracture in a fall at gymnastics. X-ray below.

On the day the bone was manipulated back manually and then plastered in a plaster of Paris cast, above her elbow.

Last Thursday the plaster of Paris cast was fibreglass reinforced (so still heavy cast, above elbow).

Plan was to remove today and set in a light, fibreglass cast, below the elbow.

Back this morning, same dr who made last week’s plan, decided to remove the cast and as the X-rays show the beginning of new bone growth that she should have nothing on..!

After 15 days. Sent away with a physio sheet.

Took her back to school looking like a baby bird with a broken wing - very very vulnerable. Dose of paracetamol and dose of ibuprofen at 10.30. By 12.30 she was asking for more pain relief so I called the hospital back.

Took her back in and they gave her a Velcro splint which has stopped the pain at the moment.

I’ve had a check on the internet and I can see nothing that says 2 weeks for a break. Yes for a buckle fracture but not a clear break which needed to be manipulated back.

I’m in shock and feel very protective of her, she feels very vulnerable being a 9 year old in a busy school.

Even with the splint I feel it’s not enough (i’m Not a dr of course, I work in the school).

AIBU I’m wanting to take her back, see another dr and insist it’s properly protected and kept in place for at least another 2 weeks..?

BathshebaKnickerStickers Thu 21-Mar-19 21:14:20

Sorry just wondering if anyone had any thoughts- we did her physio exercises and she cried in pain

GirlcalledJack Thu 21-Mar-19 21:23:22

Well I’m not sure how things are now but when I fractured my arm (a compound fracture of my upper arm) I was in a Velcro type cast/splint for around the six week mark. I didn’t have it pinned and it was manually manipulated back into place. They did say if it didn’t heal or was healing wonky they would have to pin it but luckily it healed fine.
I suppose they couldn’t do a cast as it was my upper arm but I would’ve thought your DD would be in a cast for the lower arm?

I do remember then saying that the bone heals over the top in a sort of bridge shape? Which would in turn make the bone stronger (thicker?) eventually so as soon as the ‘bridge’ connected I could gently and tentatively move it slightly.

Vole3 Thu 21-Mar-19 21:23:47

I’d be going back to A&E

GirlcalledJack Thu 21-Mar-19 21:24:57

I would ask for a second opinion myself but I’m saying that as someone with no medical training at all!

JohnHunter Thu 21-Mar-19 21:40:42

It doesn't really matter how the bone is held in place (splint or cast) as long as it's stopped from moving and your daughter is comfortable. If she's uncomfortable tomorrow despite the splint then - yes - go back. Striking the balance between holding the bone still for long enough and getting the wrist moving again isn't an exact science - and I'm not surprised that you can't easily find an answer online. You shouldn't have to insist on anything or ask for a second opinion - how long to keep the cast on is (within reason) a joint decision between you, your daughter, and the surgeon.

Purpleartichoke Thu 21-Mar-19 21:47:03

A few months ago, my 9yo dd has a really bad elbow break. She had surgery and then pins and cast for 3 weeks. They took of the cast and sent her home with a splint and a sling. Also gave us very explicit instructions that she not be bumped. She was not allowed in hallways with other children. So I had to walk her to class before school opened and her teacher has to walk her out after school. It was terrifying. However the doctor said that given her age, the bone had healed enough and what they were really worried about was muscle function. She would heal much faster using the arm
At home. And she did. They were right. We were able to skip physical therapy despite the severity of the break. If she has been younger, she would have stayed in the cast longer and needed therapy after that.

Purpleartichoke Thu 21-Mar-19 21:52:22

If she is in pain and not just sore, I would call the doctor. They may need to cast her or splint it a bit longer.

Ihatehashtags Fri 22-Mar-19 07:13:52

I’m a radiographer. The picture you posted, is that after 2 weeks or the initial break? To me it doesn’t look like there is any new bone formation. For a break like that there is no way the cast should be coming off in 2 weeks. At our hospital the protocol is:
Two weeks after break - re X-ray to determine if bone is healing
If it’s not healing then possible surgery and definitely no cast removal.
Bone only starts healing from at the earliest 7 days after a break!
The Dr is wrong! Big time!

DesparateDino Fri 22-Mar-19 07:21:33

Does seem a bit soon to be off. My dd fractured her radius and Ulna when she was 10 and her cast was on for five weeks. I'd contact them and ask for another opinion.

Harveypuss Fri 22-Mar-19 08:04:39

My son broke the tibia & fibula in his right leg in early December. Slightly different, I know because it's a leg and not an arm, but he was in a full-leg non-weight bearing cast for 8 weeks, is now in a half-leg partially weight bearing cast for 4 weeks and at next review they hope to change it to an orthopaedic boot, then lots of physio.

At each x-ray doctors have said there wasn't enough new bone formation to change the cast and we've had to wait and wait. It's been a long slog.

I think your doctor is wrong. I can't see how there would be enough new bone formation at 2 weeks warrant taking the cast off completely and it doesn't seem like it from that x-ray picture.

GenerationBlueMascara Fri 22-Mar-19 08:19:43

DD broke her humerus at gymnastics. She had plaster cast for a week to try and use gravity to pull it back into place unfortunately that didn't work and she then had surgery to pin it and was put into a velcro sling. At school she went in early to avoid being knocked and also had early lunch and left school slightly after everyone else. No advice as to whether the sling is right for your DD though.

JohnHunter Fri 22-Mar-19 09:22:51

@Ihatehashtags - I hope that your hospital doesn't employ a "one size fits all" protocol like that, and particularly for kids' fractures. Duration and mode of immobilisation should consider age, patient comfort, fracture pattern, and stability at least... To be honest, it's rarely helpful to x-ray anything at two weeks when it is too late to intervene if the position has slipped and too early to expect to see callus.

That x-ray probably isn't the post-manipulation position and we can't comment meaningfully on callus formation without the other view anyway.

That said, if the OP's daughter isn't comfortable then they should certainly go back. She'll probably end up following the original plan, i.e. a below elbow cast for a couple more weeks.

@BathshebaKnickerStickers - people come back to fracture clinic for this type of thing all the time - just give them a call. DOI: Orthopaedic doctor who spends more time than he'd like in fracture clinic.

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