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Parents and carers

Possible Scaphoid Fracture

· Nov 5, 2024 ·

What is the scaphoid bone (skay-foyd)?

The scaphoid bone is a small bone on the thumb side of your wrist.

What causes a scaphoid fracture?

Most scaphoid fractures occur when you stretch your hand out in front of you to protect yourself from a fall. A fracture is the same as a break.

What are the symptoms?

Because most scaphoid fractures do not cause the wrist to look broken and many cause only minor symptoms, it can be hard to know if your scaphoid bone is broken. If the bone is broken, your child may have:

  • Pain, tenderness, or swelling on the thumb side of their wrist.
  • Difficulty gripping things or twisting their wrist or thumb.
  • Swelling around their wrist.

It can be hard to tell the difference between a wrist that is sprained and one that is broken: x-rays do not always show the fracture.

How is a scaphoid fracture diagnosed?

It is often difficult to diagnose a scaphoid fracture. Usually, an x-ray is requested but this may not show the fracture immediately.

If this is the case, your child will be given a wrist splint for support. You will also be given a phone number to use if your child is still having pain in the wrist after 2 weeks.

If your child is still having pain, call the number to book a clinic appointment. At the clinic, your child will be examined again, and will most likely have a repeat x-ray done to see if the fracture can now be seen on this x-ray.

There are times when we will also need to arrange another type of scan to be very sure there is a break in the bone. This is called an MRI scan and will be discussed at clinic if we think you need this.

What happens in the meantime?

The scaphoid bone has a poor blood supply and, as a result, it is important that a fracture is not missed. We will assume the bone is broken until we are certain it is not as this is the safest option for your child.

This involves placing the affected wrist in a splint. This should be worn most of the time, but can be taken off for 10 minutes a few times a day to let your child’s skin breathe.

The splint will help to reduce pain and your child can also use pain medication like Paracetamol or Ibuprofen.

What if it is broken?

Treatment for scaphoid fractures includes wearing a splint or plaster cast. In general terms, if the bone is broken then your child will require a plaster cast which they will need to wear for 6 weeks. Very rarely a bad fracture may need an operation. This will all be discussed with you and your child at clinics.

Physiotherapy video

Follow-up

To make a follow-up appointment please call
Paediatric Emergency Department Reception: – 0131 312 0017 or 0131 312 0018.

Trigger Thumb/Finger

· Nov 5, 2024 ·

What is a trigger thumb/finger?

Trigger thumb/finger (digit) is a condition which causes the affected digit to “lock” as it is bent towards the palm. It can be painful at the base of the digit when it is moved or has pressure applied to it. The digit can get stuck in the bent position and then suddenly “pop” straight.

What causes trigger thumb/finger?

Tendons connect bone to muscle and enable the joint to move as the muscle contracts. The tendon sits in a protective cover called the tendon sheath, which has a small amount of fluid within it to allow the tendon to move freely and smoothly.

A trigger thumb/finger is caused when there is a problem with the tendon or sheath, for example swelling and inflammation, which causes roughness on the tendon meaning it can’t slide easily.

The exact reason for this occurring isn’t fully known but it can occasionally start following an injury to the hand.

What are the symptoms of trigger thumb/finger?

A bent digit that appears to be ‘stuck’ in that position. There may also be a clicking of the digit on movement. Pain and tenderness may be experienced at the site of the triggering.

What are the treatment options?

Trigger thumb/finger is not harmful and often resolves itself without the need for any active treatment. It is advisable to try to avoid activities that cause pain during this time.

Surgery involves releasing the tendon sheath which allows the tendon to run freely through it.

This would be done by the Plastic Surgery team, and you will be referred to them for follow up.

We usually wait for the child to be between 3 and 4 years old before carrying out surgery.

Your doctor will discuss the options with you and advise the best course of treatment for your child.

What will the follow up be?

As trigger thumb/finger is often self-resolving it may just be followed up in the Plastic Surgery Outpatients’ Clinic.

If surgery is considered the best option for your child, this would be carried out as a day case procedure under general anaesthetic (asleep) and will be discussed with you during your clinic appointment.

What should I do if I’m worried?

Ask us for help. We are here to provide more information and advice. You can either contact the Paediatric Emergency Department – 0131 312 0017 / 0131 312 0018 or the Plastic Surgery Secretaries whose number you will find on your clinic letter.

Congenital torticollis (Left side)

· Oct 21, 2024 ·

illustration labeled "Congenital Torticollis." It depicts a baby with a tilted head position, which is characteristic of this condition. The following features are marked: 1. Head tilted toward the affected muscle - The baby's head leans to one side, indicating the muscle contraction on that side. 2. Chin points away from contracted muscle - The baby's chin is turned away from the side with the contracted muscle. 3. Contracted SCM muscle - The Sternocleidomastoid (SCM) muscle on one side of the neck is shown as contracted, causing the tilt and turn of the head.
Congenital torticollis is a common condition affecting babies in their first few weeks. It presents as a tilting and rotation of the head and neck that is caused by tightness in the neck muscles. There may sometimes be a lump in the neck, which usually reaches maximum size within the first month and then gradually gets smaller.

Your baby’s head will tend to tilt towards the affected side, but they will look or turn away from it. The following positional techniques and stretches will help to correct this and stretch your baby’s muscles.

Congenital torticollis (Right side)

· Oct 21, 2024 ·

a baby with "right-sided torticollis," a condition where there is a noticeable tilt of the head. Specifically, the baby's right ear tilts toward the right shoulder, while the nose and face rotate to the left. This is due to tightness in the right sternocleidomastoid (SCM) muscle, which is marked in the image.
Congenital Torticollis is a common condition affecting babies in their first few weeks. It presents as a tilting and rotation of the head and neck that is caused by tightness in the neck muscles.

There may sometimes be a lump in the neck, which usually reaches maximum size within the first month and then gradually gets smaller.

Your baby’s head will tend to tilt towards the affected side, but they will look or turn away from it. The following positional techniques and stretches will help to correct this and stretch your baby’s muscles.

Toddler’s fracture

· Oct 21, 2024 ·

A Toddler’s fracture is a small break, often referred to as a ‘hair-line fracture’, to the shin bone (tibia), the large bone in the lower part of the leg. This type of injury is typically caused by a minor fall or a simple twisting of the leg and is very common in children under 3 years of age.

Hearing us say your child has a ‘fracture’ sounds serious. The good news is, that your child has a minor injury – the bones are stable and held in the right place, no procedures are needed, and your child will make a full recovery.

illustration of a child's bone showing a thin crack on the bone (toddler's fracture)

What tests will be done?

Your child may have an x-ray. The nurse practitioner or doctor will make this decision based on the history of the injury, their examination, and the age of your child. Toddler’s fractures don’t always show up on the first x-ray because they are so small.

What is the treatment?

The nurse practitioner or doctor will discuss a treatment plan with you as it is not always necessary to immobilise the leg with a plaster cast or moonboot. Your child may only require simple painkillers such as Paracetamol (calpol) and Ibuprofen, and rest.

What should we do when we get home?

We recommend that you give your child regular paracetamol (calpol) and/or ibuprofen for the first 48 hours. Your child will adapt to having sore leg and will change their play for this. This means they may go back to crawling or may just want to be carried. If they want to walk that is absolutely fine.

If you feel that your child is too sore despite having regular painkillers, please bring them to the Emergency Department so we can review them.

Follow-up

It may be several weeks before your child walks normally again. They often walk with a limp, or their foot turned out initially but this will improve.

If your child is not walking normally 4 weeks after the injury, please contact the Emergency Department on 0131 312 0007 or 0131 312 0008 and ask for a face-to-face review clinic appointment.

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