Medic in the house? Broken arm Q.

[CATastrophe]

Anyone with experience with a fractured or broken forearm?

Scenario:
A twelve year old boy with a fractured arm caused by a beating from his 17 year old brother.

If a lay person could tell the arm was fractured because it was at an odd angle how intensive would the setting and casting be? Does it have to break the skin to be obvious? Or would a hairline fracture be enough to cause quick and obvious swelling making the arm appear to be broken worse than it is? Would surgery be required to set it? Would the boy be able to come home after two nights in the hospital?

Thanks bunches!

[sassandgroove]

Yike.

Well, I fell off a chair and landed elbow first. I laid on the floor and cried. After what felt like forever, but was more like 2 minutes, my friend Diana came in and knelt over me. I had my arm bent and against my chest. My hand was in a fist. She tried to extend my arm and I yelped. I couldn't open my fingers without extreme pain, either. "It's probably broken," she said and took me to urgent care. They x-rayed it and found it was broken in two places and had a chip.

ETA: Oh, how it was treated. They sent me to a specialist. He took cat scans. The treatment was so counter intuitive to me. The doc didn't cast it, he put it in a splint (in a bent position). I was instructed to take the splint off once a day and try to extend my arm. He said if I didn't the muscles would atrophe. As I healed I had to keep it off longer. Then I had to go to physical therapy where they manipulated it for me and put little electrodes on my arm (so cool.) Then, she told me that while I watched TV, to keep my arm extended during the show, and use a tea towel as a weight, and during the commercials, bend it again. Oh man, I never wanted a commercial so much in my life. I moved on to one pound weights, which I am sure were more than a pound. From there it was pretty much normal. I did have pain in my elbow a year or two ago, and the doc said it was probably a result of the break and gave me a sheet on how to treat tennis elbow. Now, if I slack on my excercise/weight lifting, I notice it starts to hurt a little.

P.S. I still have the chip. I can feel it. Eww...

[Kate Thornton]

I broke my arm in 2 places last year:

Fracture - that's a break
Compound Fracture - that's where it goes through the skin

Even a hairline fracture will swell and cause intense pain. It doesn't have to be at an odd angle for it to be bruised up, swollen and hurt really bad, and look odd. Could be caused by a blow from an object (like a baseball bat) or a fall.

Surgery is required for compound fractures and shattered bones, but not usually for simple fractures. Setting (pulling by an experienced orthopedic doctor until the ends line up well) can be done right there in the emergency room and a cast that immobilizes both the arm & shoulder is put on. In a few weeks or so for a quick healing kid, a "short" cast (one that frees up the elbow) can be put on for another 3-4 weeks. There is no hospital stay w/o surgery. It's a one-nighter even for a compound fracture.

Shattered bones requiring much surgery may require a longer stay, but it would require more force (like an accident, not a beating) to produce that kind of an injury.

I fell off a ladder. I had a stroke awhile back, so don't even ask me wtf I was doing up a ladder - it was stupid!

[Variant Frequencies]

An arm could be broken during a beating when the victim raises his arms to ward off blows. An obvious deformity (bent at an odd angle or bowed) would make it easy for a lay person to tell there's a fracture, but the setting and casting wouldn't necessarily be complicated. As Kate mentioned, it wouldn't necessarily require a hospital stay at all.

[sassandgroove]

An arm could be broken during a beating when the victim raises his arms to ward off blows. An obvious deformity (bent at an odd angle or bowed) would make it easy for a lay person to tell there's a fracture, but the setting and casting wouldn't necessarily be complicated. As Kate mentioned, it wouldn't necessarily require a hospital stay at all.True. I broke my arm at 130 and was at my friend's house resting by 330. But I had to go to the specialist the following Monday. Stil wasn't too time consuming though.

And let me tell you....I needed the pain killers, man. It wasn't "oh I could just take Ibuprophen instead," no, the pain was like fire and the vicadan was like cool refreshing water.

[CATastrophe]

I ...Setting (pulling by an experienced orthopedic doctor until the ends line up well) can be done right there in the emergency room and a cast that immobilizes both the arm & shoulder is put on. In a few weeks or so for a quick healing kid, a "short" cast (one that frees up the elbow) can be put on for another 3-4 weeks. There is no hospital stay w/o surgery. It's a one-nighter even for a compound fracture.



So a forearm fracture would require a cast to include the shoulder? Or would that only be in more serious breaks like the compound fracture? If it was a hairline, it would swell and look deformed, wouldn't it? But that would not require immobilizing the shoulder, right?

Thanks everyone!

[ColoradoGuy]

The main signs of a fracture are pain, swelling, and deformity. So-called “hair-line” fractures have the pain and the swelling (although not as much of either) without the deformity. Mid-shaft fractures of either bone in the arm (thumb-side is the radius, pinky side is the ulna) would likely be treated with a cast up to, but not beyond, the elbow. Proper alignment of the bones after casting is checked by x-ray, although one can actually accept up to 20 degrees of angulation – it will straighten out later on its own. If there is too much swelling at first, one gets a half-splint for a day or so until the swelling has gone done, because casting a swollen limb just means the cast will be too loose when the swelling goes down. A simple break such as the one you describe in an adolescent would be cast for about 3-4 weeks.

[Maryn]

For those who say a fracture where the skin pierces the skin requires surgery? Nah, not necessarily. I got the scar and everything for a radius break that came through the skin. The didn't even give me stitches.

I sat in the ER waiting room for six hours, after having hidden it from my parents for at least four hours. (I was doing something that wasn't allowed because, duh, I could get hurt.) I got an ice pack and all Mom's attention. When they finally got around to me, they casted it up to but not including the elbow, like ColoradoGuy said. No stitches, no pain meds.

Maryn, good as new--until she fell on the icy driveway 45 years later

[sassandgroove]

LAst time, I promise. I broke my wrist when i was 11, and didn't need physical therapy. WHen I got the cast off, I only remember one day of awkwardness. When I broke my arm in my 20's, I needed physical therapy. I asked the therapist why, she said kids play through the pain. Adults won't do things becuase "it hurts." even if it is better to play through the pain.

[CATastrophe]

LAst time, I promise. I broke my wrist when i was 11, and didn't need physical therapy. WHen I got the cast off, I only remember one day of awkwardness. When I broke my arm in my 20's, I needed physical therapy. I asked the therapist why, she said kids play through the pain. Adults won't do things becuase "it hurts." even if it is better to play through the pain.

Interesting!

For those who say a fracture where the skin pierces the skin requires surgery? Nah, not necessarily.

This is kind of what I was thinking. Were you able to write or use your fingers if it was the nondominant hand?

[Maryn]

This is kind of what I was thinking. Were you able to write or use your fingers if it was the nondominant hand?It was my non-dominant hand (although as a kid I was close to ambidextrous) but I was able to use my fingers except as the cast impeded me. I could hold a book to read (such a book nerd!), use my knife at the table (somewhat clumsily), reach for crayons, pet the cat, etc.

For what it's worth, I remember that once the cast was off, the arm felt somewhat weak for a couple of days, and I had a tendency to guard it even though it was healed for a couple of weeks at least.

Maryn, who now has so many vulnerable places to guard she'd need a full suit of armor

[Kathie Freeman]

When I was 6 years old I broke my right (dominant ) arm. Since this was in the 50's, I had a cast that went just past the elbow and a sling to hold it in position. By the time the 6 weeks was up and I got the cast off, I was left-handed. My Mom had to pin the sleeve on my left hand to get me to go back to using the right. Even today, I'm nearly ambidexterous.