My 4 years old son fell in the play area and got his left arm fractured (ulna and radius). We went to ER and doctors did alignment and put him on 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 more than 20 % in 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 time and while playing (with toys inside the home), the sling is getting loosened. My worry is that will it delay the healing process. Does the kid always need to be in a sling while in the cast. Please advise.
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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, application of slab for one week followed by checking of X-ray elbow with the forearm with wrist-anteroposterior and lateral view to confirm reduction is maintained or not.
If the reduction is maintained, then to undergo cast immobilization. Children do not require sling at all times. Role of the sling is to prevent edema of the limb by keeping it elevated and gives support. The child can play with 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 further.
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