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Hand and wrist

Looking after a child with a wrist fracture

· ·

Diagram showing the bones of the forearm, labeled ulna and radius. In a wrist fracture, one or both of these bones may be broken

Wrist fractures are common injuries in childhood. There are two bones in the forearm – the radius and the ulna. In a wrist fracture, one or both of these bones may be broken.

Sometimes the bones may need to be put back into position by a doctor or nurse practitioner in the emergency department or operating theatre, or your child may need surgery.

Your child will need a cast to support and protect the bones while the fracture heals. It is important to care for your child’s wrist and cast correctly after you leave the hospital.

Treatment

Fractures are sore and pain is usually at its worst in the first few days. Your child will be much more comfortable when they are placed in the cast, but we would recommend regular painkillers such as paracetamol and/or ibuprofen over the first few days.

Wrist fractures can often swell, so it is very important to keep the arm raised. See arm elevation advice.

Encourage your child to gently keep their fingers moving and wriggling their and their elbow if the cast is below it.

Physiotherapy video

Follow-up

Most of these fractures heal well without any problems and we do not routinely follow them up. Occasionally we will organise a fracture clinic appointment for your child which will be given to you before you leave the Emergency Department.

You should have received advice on how long to leave the cast on for. Your child’s hand and wrist may be a bit stiff & sore when it is removed.

There may be some swelling where the fracture has been which is called callus and is a good sign that the fracture is healing.

If you have any ongoing concerns regarding your child’s wrist, please contact the Emergency Department on 0131 312 007 or 0131 312 008 and ask for a review clinic appointment.

Care of a Child in a Scaphoid Removable Cast

· ·

Why a removable scaphoid cast?

Scaphoid fractures are often very difficult to see on the initial X-rays. They can’t always be confirmed until further examination or x-rays are taken at the review clinic.

The RC or splint will help support the injured part but is easily removed and can be used flexibly depending on how painful it is for your child.

During the first 48 hours

The arm should be kept in the RC/splint and may need to be elevated in a sling in the first 48 hours to reduce the risk of swelling. Paracetamol can be taken as this is when the injury is most likely to be painful.

Your child should be encouraged to exercise their fingers and hand by curling up the fingers into a fist and then stretching them out fully in repetitions of 5-10.

If further swelling occurs

You can loosen the RC/splint, or remove it to relieve pressure. Once the cast is removed, you should place the arm back in the sling. This will encourage the swelling to go down.

If the swelling doesn’t go down within a couple of hours or there is numbness or increased pain, you should contact the Emergency Department plaster room on 0131 312 0027.

After the first 48 hours

The RC/splint can be removed three times a day for ten minutes to allow the skin to breathe and also to apply cream to relieve any itching.

It is recommended to keep it on all the time at school, as it alerts people to the fact that your child has had an injury. It also protects the wrist from any knocks in the playground.

The above are guidelines. If the wrist is painful out of the RC/splint then put it back on.

If at any time, the thumb becomes pain-free out of the RC/splint contact the plaster room team between 9 am and 7 pm any day for advice on 0131 312 0027.

Physiotherapy video

Follow-up

You will be given an appointment card before you leave. Please make sure you hand it in to reception on your way out and the receptionist will give you a date and time to return to our clinic in about 2 weeks.

If you are unable to attend for any reason, please contact reception for an alternative appointment.

Appointments: 0131 312 1547

Plaster room: 0131 312 0027

Nurse: 0131 312 0018

Care of a Child in a Brunner Removable Cast

· ·

Why a Brunner Removable Cast?

Removable casts are tailor-made and applied by practitioners experienced in casting techniques. A Brunner RC is applied for fractures to the thumb and also for significant soft tissue injuries to the thumb.

The RC is easily removed and re-applied if required.

During the first 48 hours

The arm should be kept in the RC and elevated in a sling at all times during the first 48 hours to reduce the risk of swelling.

Paracetamol can be taken as advised by the doctor or emergency nurse practitioner as this is when the injury is likely to be most painful.

Your child should be encouraged to exercise their fingers and hand.

If further swelling occurs

You can loosen the RC, or remove it to relieve pressure. Once removed, place the arm back in the sling. This will encourage the swelling to go down.

If the swelling doesn’t go down within a couple of hours or there is numbness or increased pain, you should contact the accident and emergency department on 0131 312 0007.

After the first 48 hours

The RC can be removed three times a day for ten minutes to allow the skin to breathe and also to apply cream to relieve any itching.

It is recommended that your child keeps the RC on all the time at school, as it alerts people to the fact that they have had an injury and that they should be careful not to knock it, it also protects the thumb from any knocks in the playground.

The above are guidelines. If the thumb is painful out of the RC then put it back on. If at any time, the thumb becomes pain-free out of the RC contact the plaster room team between 9 am and 9 pm any day for advice on 0131 312 0027.

Care of a child in a removable cast or wrist splint

· ·

Your child has had a removable cast or splint applied. This is to help the injured area heal and to protect it. It will also relieve pain.

Why a removable cast?

Breaks to the bone or significant soft tissue (muscle, tendon or ligament) injuries can be managed with either a removable (soft) cast or a wrist splint. Both are easily removed and re-applied if required.

During the first 48 hours

The arm should be kept in the cast/splint and may be elevated in a sling in the first 48 hours to reduce the risk of swelling. Paracetamol and/or ibuprofen can be taken as required.

Your child should be encouraged to keep moving the fingers to prevent stiffness and help with swelling.

If further swelling occurs

You can loosen the cast/splint or remove it to relieve pressure. Once removed place the arm back in the sling or elevate it on a pillow. This will encourage the swelling to go down.

If the swelling doesn’t go down within a couple of hours or there is numbness or increased pain contact the Emergency Department on 0131 312 0007 or 0131 312 0008.

After the first 48 hours

The cast/splint can be removed 3 times a day for ten minutes to allow the skin to breathe.

It is recommended to keep the cast or splint on all the time at school, as it alerts people to the fact that you have an injury, it also protects the sore bit from any knocks in the playground.

It is recommended to wear the cast or splint for 7-10 days in total.

Follow up

After 10 days if your child is still having lots of pain, phone appointments at 0131 312 0007 (10 am – 10 pm) and book the next available Emergency clinic.

Contact NHS Lothian