ds(12) broken elbow - second opinions

[BrokenWing]

Any orthopaedic experts about?

Ds broke his elbow last Friday, had a half cast put on by A&E. He saw the consultant for 30 secs on Monday who said it was too swollen and skin broken to do anything yet so back into a half cast and another appointment really next week.

The consultant said the break isn't displaced much so he won't need surgery to pin back in place, a full cast should do one the swelling goes down.

My uneducated eye is worrying about the piece at the end sticking up where it shouldn't and causing ongoing issues. Any second opinions?

It’s sort of meant to stick up like that, if you look at a normal x Ray. Once in a proper cast it will very likely heal normally so I wouldn’t panic

I've looked at so many pictures of elbow xrays and I cant make my mind up if it might cause him problems straightening his arm fully.

Looks normal to me (aside from the break, obviously!) Ask whoever you see about it this week.

I think the bit you’re worried about stopping him straightening his arm, is the olecranon, and that’s what is normally there to stop the arm hyper extending. But yeah chat to whoever you see next and they should set your mind at ease

1st is dislocated 2nd one is not dislocated. They did make a mistake with 1st one and only spotted break. So ended up with an operation 5 weeks later. No expert though but if you are unhappy then definitely get another opinion

I have health insurance through my work so could ask for a referral to another hospital (30 miles away), but if the treatment will simply be a cast either way, then might as well stick to our local hospital.

Any opinion that you are offered based on the OP and a single radiograph (they should always come in orthogonal pairs) is not one that's likely to be helpful. Was there a reason to doubt the advice of the consultant in clinic?

If you are back next week then mention your concerns. They will look at the X-ray again. It may even be that you will see a different doctor.
But definitely ask the question.
If they have got it wrong and they do need to operate then again don’t let yourself be scared by internet stories.
My DD’s dislocation was missed and the internet panicked me. And all I could find was arguments about how best to operate and how the outcome was not so good after 4 weeks.
My DD did get a wire in her arm, she did need physio and it did take her a few months before she could straighten her arm fully - but her arm is now basically back to where it was before. Or if there is a difference it is negligible.
i don’t think your private healthcare will be any use I’m afraid although worth a call.
We did ask the question about getting my DD operated on privately with our healthcare provider but they basically said they would struggle to find anyone who would look at her.

Another thing you could maybe ask is for them to X-ray the other arm too.
The.mn they can compare them both.

I am an orthopaedic expert but I am not going to diagnose your son looking at half an X-ray.

(He has definitely got an abnormality due to a raised posterior fat pad).

Listen to your consultant.

Ok, saw 2 "consultants" yesterday, not filled with confidence.

Skin is healing up nicely now. Both consultants said nothing to worry about and first one said put him back into a huge/heavy full arm back slab (half cast thing) with loads of bandages and we've to go back in 3 weeks. Tried to ask 1st consultant some questions and frankly he was a patronising prick who basically said we know what we are doing.

2nd consultant looked at and said yes should be OK, honestly it will be fine children usually heal well, let's see after 3 weeks.

Went to plaster room to get it done and nurses said why are they putting him in a back slab? It won't last 3 weeks and full cast is lighter and cooler (previous back slab was talking to bits after 1week!). They went and found 2nd consultant who agreed but wanted to check with the grumpy first one. First one had left so he couldn't be asked and 2nd one didn't want to change even though he disagreed (get the feeling 1st one was senior) so we are stuck with this huge bandaged up thing that is roasting and awkward.

And now I am worried about and Googling 'fat pads' 🤪

Honestly I'm not an anxious person generally, only when ds (or the dog) are ill/hurt. Dog recently had orthopedic issues and the confidence in the care provided was much higher!!!!

worieddd never saw your message until today, so never asked about 'fat pads'

The "fat pad" @worieddd is referring to is just a small shadow at the back of one of the x-rays, which indicates that there is some fluid (probably blood from the fracture) in the joint. It is not important by itself but indicates that there is a fracture somewhere - in this case it is clear where that is.

It sounds as if Mr Grumpy was the consultant and Mr Uncertain was one of the juniors. Is it truly a backslab (i.e. just a strip of plaster on one side wrapped up with a bandage) of a full plaster-of-Paris cast? I wouldn't expect the former to survive very long. In any event it would have been kinder to provide him with a fibreglass cast, which would be lighter and more likely to survive three weeks. If it is truly a backslab or your DS is uncomfortable then I'd telephone and ask for a change of cast.

Thanks John. It is a back slab which was made with plaster strips over a stocking, under the arm and doesn't encase the whole arm all the way round and is covered with lots bandages. With the last one the bandages were all baggy and stretched after sleeping in them for a week.

The nurses were sympathetic as they couldn't understand why he wanted a back slab again and said if the bandages do get baggy again to phone and come in and they will re-bandage for him.

They weren't keen to go against Mr Grumpy's instructions so not sure how I would approach asking for a full cast when Mr Grumpy has already told me he is the one who knows what they are doing. Ds isn't a complainer so will cope with it, but shouldn't have to, and we could do without weekly trips to get the bandages sorted out.

I suspect that Mr Grumpy said "backslab" but really just meant that he should go back in a cast for three weeks. I'd give them a call at your convenience and ask for the cast to be switched.