- After you check in, you and your child will be shown to one of the exam rooms. There are reading materials in the exam rooms, but a parent may want to have some toys or other distractions available for younger children.
- Your child will then be seen by one of the hand and upper extremity surgeons in our practice: Dr. Jeffrey Wint, Dr. Bruce Wintman, or Dr. Richard Martin. You can be assured that at every visit to our practice, your child will be evaluated by a doctor.
- Your doctor will start out with some questions and then move on to a physical examination. He will take great care in examining the injured extremity, being as gentle as possible.
- X-rays of the injured hand or wrist may be necessary even if X-rays were obtained in the past. This may be for a number of reasons including checking the current position of a fracture, looking for unrecognized fractures, or requiring special views of the bones and joints. If an X-ray is needed, your child should not worry. This is not a painful process. Our Certified X-ray Technician will be there with your child throughout the process and to help position the injured upper extremity. The parent need only step out of the X-ray room momentarily while the X-ray is taken.
- After the X-ray is processed and evaluated, you will be seen again by the doctor to go over the findings and discuss the diagnosis and treatment.
- Treatment depends on the injury but may range from splinting, casting, closed reduction to surgery. Your doctor will review all the options and give you his recommendations. Your doctor will make sure you and your child have a chance to ask any questions you might have.
- If casting is necessary, there is a separate room with casting supplies where both you and your child will be brought. Applying the cast is not usually painful; however, if some reduction of the fracture is necessary, your surgeon will warn you and your child ahead of time.
- Many children wonder whether removing a cast will hurt. It does not. The cast saw is loud and vibrates, so it may be a bit unsettling. It will not cut your child’s skin.
If your child requires a formal fiberglass cast, there are a number of colors to choose from. The following colors are usually available upon request: Navy Blue, Light Blue, Green, Red, Black, Pink and Off White (standard). Orange and Purple are not usually available. There is no extra cost associated with a colored cast.
- Keep the cast dry. If the cast gets splashed with water, simply let it dry. If the cast gets completely soaked it may need to be changed. Do not panic Let the cast air dry that day or use a hairdryer or blow dryer on a cool setting. While there are times when a new cast must be applied over the next day or two to avoid skin irritation or breakdown. There are times when the physician may decide that it is ok to keep the same cast. Let your physician be the judge of what is needed. Contact the office for questions. Your injured child should stay away from pool areas as the temptation of water is strong, and nearby children can often times foil your best efforts. There are devices on the market to keep casts dry; most of these do not work well. These devices -- or alternatively a newspaper plastic bag and rubber band -- may be worn for showers only; however, the arm should still be held up and out of the shower to avoid leaking.
- Cold may be applied to the cast to alleviate pain and swelling. An ice pack wrapped in a towel or alternatively ice in a sealed Ziploc bag wrapped in a towel is usually effective. Remember you do not want any moisture to seep into the cast.
- Do not stick anything down the cast. Items are often lost in a cast, and this will necessitate removing the cast to prevent any skin irritation or breakdown.
- Do not stick longer items down the cast to scratch an itch. This can cause inadvertent injury to the skin and in some cases cause an infection. If you do have an itch, you may try using a blow dryer on a cool setting.
- Do not expose the inside of your cast to dirt, sand, or powder.
- Do not remove or revise the cast yourself.
- For the first several days after a new cast is applied, it will likely feel snug. It is usually beneficial to elevate the injured extremity higher than your heart. The easiest way to achieve this is to lie down, place two pillows on your chest, and rest your hand and wrist on the pillows.
- Feel free to have people sign or decorate your cast with markers or stickers. Silver or Gold Sharpie markers are commercially available and work well for darker colored casts.
- You may notice some swelling in the fingers or any portion of the hand which is not covered by the cast. Swelling may even occur several days after the cast has been applied. There are several steps you can take to minimize swelling: elevate the hand and wrist as described above, move the fingers (if allowed) to improve venous return and help with joint motion, apply ice to the swollen area as described above, and keep the room temperature low.
- If you experience new numbness and tingling of the fingers which persists despite attempts to decrease swelling, call the office for further instructions.
- If you feel the cast is digging into your skin in a specific area, call the office for further evaluation.
- If your cast feels too tight, this may represent some temporary swelling. First attempt to decrease the swelling as discussed above. If the tightness persists call the office for further instructions.
- If your cast feels too loose, do not try to “test it out.” Do not shuck the cast back and forth. Try to take it easy with your injured extremity. All casts will loosen somewhat over time; this does not necessarily mean the cast is ineffective. If the loosening seems excessive call the office.
After your child has been diagnosed with a fracture and the appropriate treatment is recommended, you start to wonder about how this will all affect your child’s regular daily activities. One question is usually at the top of the list – especially during the summer months -- “can we have a waterproof cast?” The answer is, “it depends.”
Waterproof cast material is applied as an under layer of padding before the outer layer of fiberglass is applied. This waterproof material is able to dry following exposure to water, but will lose some of its shape and thickness over time. Certain fractures are unstable and are predisposed displacement if there is too much motion within the cast; these types of fractures are best treated in the more standard non-waterproof cast. Still other fractures about the hand and wrist are more amenable to various non-removable non-waterproof. If you have a desire for a waterproof cast, you should ask your doctor at the time of the original visit, before the cast is applied. Your doctor will let you know if he thinks your child would be a good candidate for this type of cast.
There is also the consideration of cost for some families. Most insurances will only cover the cost of a standard non-waterproof cast. The additional cost of applying a waterproof cast is $40 although this price is subject to change.
If your child is ultimately treated with a waterproof cast, there are still some rules to follow. Your child should swim in a pool and avoid the beach. Any material, such as sand, that goes into the cast may cause irritation or worse. Remember, your child still has a fracture and should avoid rough housing in the pool. After swimming or showering your child should allow time for the cast material to thoroughly dry. Using a blow dryer on a cool setting can help with this process. As with any cast, never stick anything down the cast, even to scratch the area as this could cause skin injury.
If your child is treated with a non-waterproof cast, the cast must be kept dry. Your child should stay away from pool areas as the temptation of water is strong, and nearby children can often times foil your best efforts. There are devices on the market to keep casts dry; most of these do not work well. These devices -- or alternatively a newspaper plastic bag and rubber band -- may be worn for showers only; however, the arm should still be held up and out of the shower to avoid leaking. If a standard non-waterproof cast gets soaked contact the office as there are times it may need to be changed. Please see cast care link for further instructions regarding cast care.
You may have seen professional athletes on TV playing with casts or splints on their hands or wrists. Other people, including family, friends, and trainers, may have told you and your child that it won’t be a problem participating in sports immediately after a fracture. The truth turns out to be more complicated.
There are many factors involved in the care of a fracture and the ultimate return to sports.
Every fracture has its own personality. Some fractures are very stable and start off in relatively good position. Other fractures can be unstable and require surgery with pins, plates or screws. Some fractures may involve the joint surfaces and may require more care to prevent displacement and complications later on. Different bones also have different healing potentials with some taking longer to heal. The age of the patient and severity of the trauma also play an important role in determining the prognosis and ultimate course of treatment.
Different sports also have different requirements regarding return to play. A soccer player or cross country runner may be able to avoid using his or her hands all together. Still other sports run a high risk of re-injury due to the increased contact, unpredictable nature, and significant force involved in the activity, i.e. football, hockey, and wrestling. Different positions in a particular sport may also affect the decision of when to return to play: kicker vs. quarterback or striker vs. goalie.
The decision of when to return to sports must be individualized for every patient. A parent must realize that a child is not the same as a professional athlete. With a professional athlete, there may be significant financial considerations which factor into whether an athlete should return to play – a professional athlete may be willing take on the risk of re-injury or irreparable problems in the future for immediate glory or fortune. For most children and teenagers with a fracture – and indeed most adults not competing at a professional level – a more conservative approach is warranted.
The discussion of when your child can return to sports should take place between you and your doctor. If your doctor feels that your child may participate in sports with some restrictions, one must realize that there is still a chance that some unforeseen event may occur. There are rarely if any certainties in medicine as in life. Your treating hand and upper extremity surgeon must try to weigh all these factors in order to determine the best course of action for your child’s injury. If your doctor tells you that your son or daughter should not participate in sports at this time, it is because he feels this will ensure the best outcome for your child’s fracture.
Life with a cast on can certainly be challenging. There are a number of issues surrounding school which often arise.
- When can my child return to school? With hand and upper extremity fractures a child may usually return to school when the pain of the injury is tolerable. For most children, this is usually possible at 1 to 2 days after the injury. A child may require Tylenol or Motrin medication for some discomfort. If your child has extreme pain with the arm hanging down by his or her side or while walking then it may be too soon to return to school.
- Can my child write with his hand or wrist in a cast? This is usually not a problem for the majority of fractures. A child may need some additional time for writing assignments, and an doctor’s note can be written to this effect.
- My doctor told my child he should not use the injured hand at all? In the rare instance that your hand surgeon tells you that your child is unable to write with his injured hand, a note can be written to ask the school to make allowances for this circumstance. Sometimes notes, assist devices, or an aide can be temporarily provided.
- Can my child participate in gym or sports? Please see the link regarding sports and fractures. This discussion will help you understand the factors involved in making this determination. Ask your doctor about participation in any activities with which your child is involved. A note for restrictions regarding gym and sports can be provided if necessary.