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Q. Is it necessary to be in sling always for an arm fracture?

Answered by
Dr. Sumit Chawla
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Apr 06, 2016 and last reviewed on: Oct 09, 2018

Hi doctor,

My 4 year old son fell down in play area and got his left arm fractured in the region of ulna and radius. We went to the emergency room immediately and the doctors did alignment and put him on cast and sling. Can you please check the x-ray and confirm the alignment? Since he is 4 years old, he is not keeping the sling all time. While playing with toys inside home, the sling is getting loosened. My worry is that, will it delay the healing process? Does the kid always need to be in sling while cast? I am attaching all the x-rays of my son. After looking into the x-ray, I had asked about the second bone not realigned properly. They told that it is fine if the alignment is greater than 20% or something like that. We are again going for a follow up in two days time. Please suggest if we need to ask them anything else during our follow up visit. Is whatever the doctor said appropriate in his case? Kindly guide us.

#

Hello,

Welcome to icliniq.com.

  • The reduction is not appropriate in this case, bone might join in a 4 year old child but this is certainly taking risk.
  • Child requires removal of cast, reattempt at close reduction, application of slab for one week followed by check x-ray elbow with forearm with wrist-anteroposterior and lateral view to confirm reduction is maintained or not.
  • If reduction is maintained then to undergo cast immobilization.
  • Child do not require sling at all times. Role of sling is to prevent edema of the limb by keeping it elevated and gives support.
  • Child can play with well fitted cast provided if there is no fall on the limb and the cast is not soft or broken.
  • My answer is still the same. If the contact between two fracture ends is 100% with no fracture displacement and no malalignment then the rate of bony union is high.
  • In your child's case, bone is malaligned. Fracture may unite and later undergo remodeling process. If duration of three weeks has already passes since injury, get fresh x-ray done. If there are signs of union, continue cast.
  • If no signs of union or less than three weeks then there are two options, either to wait or reattempt close reduction.
  • Bone contact is separate for both bones. Ulna (one of the bone) is aligned with near 95% reduction which is satisfactory. Whereas radius, another bone is not in contact. Bone contact is present in one view whole not in other which means there is no contact.
  • Bone can still unite even when there is no contact, but chances are very less.
  • Ask your doctor to repeat x-ray and follow up with those x-ray images to discuss the situation further.
  • Ask your doctor whether the bones are showing signs of union or not.
  • Please mention the total duration since injury, slab and later cast.

For further information consult an orthopaedician and traumatologist online --> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist

Hi doctor,

The injury has happened 5 days back. Casting was done on the same day and the x-ray before and after casting was also done on the same day. We are going for a follow up after two days.

#

Hi,

Welcome back to icliniq.com.

Thanks for your prompt reply.

  • Fracture is still fresh. On the day of your follow up my recommendation is to attempt closed reduction one more time. If better reduction is achieved chances of union are greatly enhanced.
  • Reduction can be attempted under analgesia or under anesthesia. Confirm reduction under fluoroscopic C-arm control then apply POP (plaster of Paris) splintage.
  • Ask your doctor for second attempt at closed reduction as the current reduction is not satisfactory.
  • Consider the matter open to discussion. Follow up with direct questions and doubts.

For further information consult an orthopaedician and traumatologist online --> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist


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