Childhood Diseases

Posted by: BMJ | 2012-02-14


Broken arm again

Dear Doc

You will remeber this post...
My son broke his arm (buckle break near wrist - radius) on the 20 January. We were instructed to return after two weeks. The xray showed the arm was not healed, but the fibreglass cast had 3 pressure sores so the cast had to be removed and replaced. During the removal of the cast, the heat caused by the blade friction caused some of the soft fibre padding underneath to melt into his skin and caused a burn. My son was very traumatised. Because of the wound and the trauma the dr did not replace the cast again, but used a modified ''backslab'' to immobilise the arm. You suggested we get the skin wound healed as soon as possible and then have a full cast put back on. I went back, but the dr was adamant that it would be to traumatic for him. I am due back again on the 20 Feb. In the meantime, I have changed the bandage a few times, and when we changed dressing my son would have a quick shower. What concerns me, is that he seems to still have pain. When I wrap his arm again, just holding it lightly seem to be sore. Once wrapped it is ok. I was wondering if I should go back earlier than the 20th. I would have thought his arm would be all healed by now. On friday it will be 4 weeks. I was concerned that the backslab did not immobilise his arm fully and i wondered if it hampered healing. On the other hand it was VERY traumatic to have the cast off. Help me please!

Expert's Reply



You have described the situation very well.It does appear that your son's fracture has not healed as he would not still be in pain if it had.The pain disappears when his arm is wrapped.This type of fracture usually takes about 6 weeks to heal. The problem here is that a backslab alone does not seem to support his arm and wrist adequately.I do agree that putting the cast back on will be traumatic for him when the time comes to remove it. This is a real dilemma.It would be difficult to get a second opinion at this stage, but given the problems you have had up to now including the unacceptable result of applying a cast that caused 3 pressure sores, it may be the way to go.

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