Suspected Scaphoid Fracture - advice (not medical) please

[luckylavender]

I'll give you all the background so as not to drip feed.

DS is 16 and in L6 at local private school where he has been since Nursery. He is very sporty as well as academic. On Saturday he was playing rugby about 50 miles away for school, DH was away and I decided not to travel and get on with other things, so for the first time in a long time no-one was at the match.

He called me about 4pm to say he had hurt his wrist and was going to hospital, then he called to say he would wait until he got home. He arrived at school at 6.45, it was freezing and he was in short sleeves. He is quite pain resilient but was clearly in a lot of pain and he had to scramble about in the bottom of the coach to get his very heavy bag out - no-one helped him.

At A&E they x-rayed it but apparently scaphoid is very difficult to detect so we were referred to orthopedics. We saw the consultant who advised a CT scan, which we are waiting for and advised a cast for now.

So DS has been in school in school PE kit, where normally he would wear a suit. Incidentally he loves wearing a suit and takes quite a pride in himself.

Yesterday his House Master told him he had to read in chapel today and so he had to wear a suit and that there was no way he could wear PE kit for another 8 weeks. He managed (with my help) everything but a jacket but I am not sure he will be able to go to the loo easily. He hated having my help to dress himself.

So I am annoyed. I realise he is in 6th Form but I think that a) someone should have called me on Saturday, b) someone should have helped him get his stuff off the coach and c) that it is totally unreasonable to tell him to wear a suit when it will be difficult for him to manage.

Am I being a bit precious or should he suck it up? I can't remember the last time I complained about anything and he is very independent so it's not as though I am always banging on the door. Any opinions welcome.

I would agree with a) and b) although to a) he may have said "don't worry, I'll call mum".

However I don't see that he's going to struggle with a suit. I remember at school several times people with broken arms, and none of them ever wasn't wearing uniform-this was trousers (or skirt for a girl) shirt, tie, blazer, or suit and tie in the 6th form. The jacket would go on one side, and often be loose over the top of the cast (ie just round the shoulders)

My 9yo dd has only one hand, and I can assure you that not only is it possible to deal with trousers going to the loo, but also her friend with no hands also manages (one of the adults says "how do you manage fly buttons?" is one of the most popular questions when he goes into schools to talk ) She also does her tie herself, and if necessary, her shoelaces. Yes, it is easier when you're used to it, but it is more than possible if you encourage him.

DeWe - it may be the movement that is an issue with putting on constricting clothes. OP - tbh I wouldn't expect much sympathy from school.

DD broke her upper arm last year in an accident in PE. It couldn't be plastered, and so she was in an immobilising velcro contraption under strict instructions that the break mustn't be knocked or jogged in any way as the healing bone could part.

She was keen to go into school, but got basically zero support in following the medical instructions. Fortunately she is very assertive and robust - but, for example, she got a major telling off from the head teacher because she didn't have her costume on for a play rehearsal (she could only wear very loose tops that the immobiliser would fit underneath - her class teacher and TA were both fully aware of this - she got in further trouble for trying to explain . . .)

From the experience of other friends whose children have had medical problems or accidents I would say expect zero assistance or co-operation from school, and be pleasantly surprised at any received.

(School did call us after the accident - but were pretty much 'oh, do you really want to take her to a&e' . . . again unless your child is in floods of tears or howling in agony - not dd's style - I think the attitude is that they're probably ok.)

I've fractured my scaphoid in the past and your DS has my sympathies. Mine was undiagnosed for ages due to the difficulty in x-raying it.

That being said, I'm rather with DeWe on this - it's not a hugely debilitating injury. The thumb on my left hand was pretty much out of action for a few weeks which was inconvenient as I'm left-handed but that was the extent of the problem.

I was living on my own at the time and the only things I recall being particularly difficult were doing up the cuff on my right shirtsleeve and holding a pen for any length of time. Oh, and riding my motorbike but as it was falling off the thing that caused the injury in the first place that maybe wasn't too much of an issue

How the school handled it is a different issue. I think it does depend a lot on what your son actually said to the teacher(s). I know my 14yo DS probably wouldn't say anything to a teacher about an injury (particularly if his mates were around) unless his leg was actually hanging off.

I hope your son gets well soon!

My son fractured his playing rugby. It was also hard to confirm and very painful. However he managed to get dressed. I really don't see why your (young adult) son would need to wear PE kit

I do some of my work in an independent school re: a) someone should have called me on Saturday, many of our children when ill injured ring their parents and tell us they have and we frequently say if you mum/dad wants to be speak to me tell them to call. So no I don't think they should have rung you personally especially if they saw/heard him ringing you. Was he playing rugby? There are now so many injuries from rugby that many independent schools now have a trained medical professional on the side of the pitch and all injuries are assessed at most schools the coaches take a first aid kit for this type of thing if they don't you should ask why not? Re: b) someone should have helped him get his stuff off the coach yes they should have done but when kids teachers get off coaches then often these things get forgotten it also strikes me that the coach hadn't grasped how serious this injury was Re: c) that it is totally unreasonable to tell him to wear a suit when it will be difficult for him to manage. Many independent school are monumentally petty about this kind of thing one I worked at made a child where long trousers instead of shorts (in the summer) with a severely broken leg with large external metal traction, the trousers had to cut above the knee of the broken leg and his school shoe on the other foot instead of a trainer which would have given him better grip. Another insisted that the children wore blazers and jackers in the classroom despite the fact that the weather was 85 + and they kept fainting!! Try writing directly to the head for some reason I've never been able to fathom often he the only one who can make such monumental decisions.

I think someone should have helped with his bag- where were his friends?

But I don't understand the PE kit thing- why does having a damaged wrist stop you wearing normal clothes? My ds broke his wrist badly when was in year 2, qnd very quickly learned how to manage his trousers!

Interesting responses, thank you all.

I agree with a) (just something my mother had a bee in her bonnet about so I thought I would ask).
b) he was playing rugby yes and they had good first aid staff there. They recommended that he took the coach with the boys from 3 years below as it was emptier and so he had room to put his feet up. He has loads of friends but none of them were on that coach.
c) I was undecided about, as it does seem problematic but we'll see how he gets on today. He is left handed and it's his right hand, not sure how relevant that is. For the record he has a mate who injured his arm earlier in the term who wore PE kit for weeks and no one said a word. Maybe that's clouding my judgement.

I've broken the same bone; as others have said, it's not an injury that stops youwearing a suit, its just a bit difficult.

At every school I have worked at a brokenbone has not meant not wearing uniform, so I don't understand why this is an issue

My first reaction is to say that a broken wrist/arm shouldn't affect the wearing of school clothes, he just needs to get over it and deal with the incovenience of not having both hands, especially as he has not broken his writing hand! If kids at my school break limbs they wear school uniform. Might it help to get a short sleeved shirt rather than a long one if a long sleeved one is tight over the cast?

Sorry to be blunt, but secondly, he is in the lower 6th, surely if he was struggling to get his bag out he is old enough and mature enough to ask someone to help him! A 16yr old should be developing these skills after all in less than 2 years he will be fending for himself totally without you at university.

I fractured my scaphoid a few years back while I had a PT job, an 18 month old and was pg. It wasn't that big a deal, yes it was awkward but I managed to wear formal clothes (teacher) and change nappies etc. It's certainly manageable!

My ds is right handed, and he broke his right wrist really badly when was in year 2. It happened on Friday- he was at school on Monday in ordinary uniform. The only thing he couldn't manage at first was lunch time- he's not a sitting down sort of person. So I took him out for lunch every day for the first week. Apart from that life went on as usual.

The accident / injury should have been recorded, and I think, ideally, the school should have contacted you. Why was he so cold? Even for 16 year olds they have a duty of care and someone should have kept an eye on him given that he was injured.

As for clothing - get him to practice, and maybe put some temporary velcro in where it would help.

Thanks again

trinity0097 - I am well aware of his age thank you and he has very good social skills. He got the bag himself, as he could, it was just very painful and I think that the school should have sorted it out for him. He is very independent.

Short sleeved shirts are not allowed.

Thank you Blu - I agree and I also think he was in shock. No painkillers until we got to our A&E which was 3 hours after it happened. I don't think velcro is possible as he has to wear a proper suit. No velcro on shoes either.

He will be fine, it's all a learning curve.

And no, he doesn't need a CT- complete overkill (dare I ask, was the consultant private?!). He needs an orthopaedic review in 10 odd days time, after that much time in plaster. If the pain is still 'scaphoid-fracture like' they may either re-plaster it for a further 2 weeks then check, or do an MRI scan (no radiation).

The vast percentage of '?scaphoid fracture' turn out to be a sprain but scaphoids are taken 'seriously' just because it's that particular bone, which you may already know about: It only has a blood supply to one end so if it is broken, and if it doesn't mend (i.e. becomes a 'non-union' fracture), one end can effectively 'die' due to lack of blood which can have ongoing repercussions. Hence the POP and 10 day check. But don't let them CT scan it!

Both of my dd's ended up in the same cast this summer.

OP - get a cast cover from Limbo -makes life in a cast very much easier wrt to bathing and showering and hair washing. They give great service and send the cover by return of post.

I hope he recovers soon. Once the pain, swelling and bruising settle he will be much more comfortable using his fingers if they are sticking out of the cast.

(DS has spent months, on and off, with full leg casts, but no arm / wrist yet. I had to cut his pants up the side and sew velcro down the seams to enable him to get them on, once. Velcro on shirt cuffs might help?)

we have been through similar experience recently. scaphoid fracture can be difficult to detect on X ray and sometimes it cannot be found on X ray until it starts to heal, so they often redo the X ray after a couple of weeks. We were referred to fracture clinic to scaphoid specialist - need to be careful with scaphoid due to blood supply.
However, it is very common these days to wear a splint rather than a cast which could be easier for your son to manage with clothing, etc.

HTH

Erebus- Orthopaedic consultant suggested the CT scan, not us. NHS not private ?! - copying your grammar here. It was done on Wednesday and we are seeing her again on Wednesday - which will be 11 days.

Blu - we got a cover from LImbo, it's great thank you. They suggested it at the hospital.

DS would never ask for help, nor moan, he is the quiet type.

Still very painful but he is managing fine although there has been no swelling which is strange (they think at hospital too).

Erebus in my other job I work in paediatric A and E and acute paediatrics I can assure you that the NHS does CT wrists.
I think you've answered the question yourself by saying he wouldn't ask for help moan. I dont know how many teachers went but they can't watch all the children all the time and are also more likely to be watching younger one. If your DS did not mention it much after it happened didn't ask for help and appeared pain free and you obviously didn't give him any pain killers either so he obviously wasnt making much fuss then I genuinely don't think the teachers can be blamed for not taking more care.

Dd has broken her scaphoid on her right hand 3 times - rugby, netball and roller skating.

It is very painful I think - so your son has my sympathies - and the first time she broke it the school said they thought she had a sprain. It is a difficult one to detect.

But - apart from showers which we managed by the Limbo casts - life went on as normal. She wore her normal uniform, and this summer when she broke it again she carried on doing her summer job. It was all right.

I agree though that it seems strange that another boy at the school was allowed to wear PE kit with a hurt arm and your boy isn't. I don't know if you will get anywhere raising that as an issue though.

Dd had a CT scan as well as her wrist was still painful after 6 weeks. The cracks in the scaphoid are really difficulkt yo detect it seems.

school nurse and I perform MRI scaphoid scans every day as we don't believe in firing children full of unnecessary radiation these days.

The NHS should not be doing CT wrists as routine, especially on children. The correct course of action with a suspected scaphoid in A&E is to perform an Xray and look at it. If symptomatically a scaphoid fracture is suspected but no fracture is seen, scaphoid or otherwise, a cast or splint is applied and the person returns to orthopaedic clinic 10 odd days later and the cast is removed. If the pain is reduced and/or no longer of the fractured scaphoid variety, that's that- maybe with some physio prescribed.

It is only when either the pain remains intense that a further xray may be taken, then either a fracture is now seen, or an otherwise 'missed', now obvious fracture of another wrist bone is seen that further action needs to be taken, usually further casting and review. An MRI of the wrist looking specifically at the scaphoid might be done if then a non-union fracture is suspected.

CT tend to be done when 'all else fails', no fracture can be detected yet bony fracture is still high on the list of probability due to the nature and duration of the pain.

I am finding this discussion very interesting so thank you all again.

There has been a by product too I think. DS has been veering off and on with medicine for a year or two now and this has given him a renewed interest so it could be a silver lining, if that is what he wants to do. He is certainly capable.

I think I have probably missed a vital part of this story (for those of you who are still interested!). DS is doing 3 Science A Levels and Sports Science / PE. He is a really keen sportsman - cricket is actually his main sport and he is very good at it. He spends a lot of the time he has free at school in the gym, coaching other teams, training etc. He is coaching the 5th XV rugby team now that he is injured. All of this is encouraged by the school who see that he has a great discipline of the sports field and encourage him to be a "Sports Leader". So he spends a lot of his day changing in and out of sports clothes every day, he doesn't just dress and go to school. It is not unusual for the "sportier" boys and girls to remain in sports kit as there is sometimes not enough time to get changed. Certainly there are many teachers who remian in sports kit all day who teach maths / history / physics etc. It is a busy school.

He'd better get some work experience sorted ASAP then!