Is 20 % bone union after a fracture enough in a kid?

Question

Hello doctor,

My 4-year-old son fell in the play area and got his left arm fractured (ulna and radius). We went to the ER, and the doctors did the alignment and put him in a cast and sling. I am attaching the X-rays before and after alignment. In the X-ray after alignment, one of the bones was not aligned properly. The doctor said that it is fine if it is aligned with more than 20 % of kids. I am attaching both the X-rays. Can you please check and confirm if it is fine? Also, since he is 4 years old, he is not keeping the sling all the time, and while playing (with toys inside the home), the sling is getting loosened. My worry is that it will delay the healing process. Does the kid always need to be in a sling while in the cast? Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

The reduction is not appropriate in this case; the bone might join in a 4-year-old child, but this is certainly taking a risk. The child requires removal of the cast, reattempt at the closed reduction, and application of a slab for one week, followed by checking of X-ray elbow with the forearm, wrist-anteroposterior and lateral view to confirm whether the reduction is maintained or not. If the reduction is maintained, then undergo cast immobilization. Children do not require a sling at all times. The role of the sling is to prevent edema of the limb by keeping it elevated and giving support. The child can play with a well-fitted cast provided there is no fall on the limb, the cast is not soft and broken. If there is anything else, feel free to discuss it further.

Thank you.