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broken wrist, to sling or not to sling
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broken wrist, to sling or not to sling

Hi,
My 10 y/o daughter broke her wrist, a complete snap of both bones in the lower forearm, about where you would wear a wrist watch.  It was badly bent, but no break to the skin.

She was put under general anaesthetic (scary), and the wrist was straigtened and a cast from hand to elbow was applied.  She did not wear a sling, as it aggravated her neck.

2 weeks later, an x-ray indicated the arm was not straight, and she was put under again, and the wrist was straightened (hopefully), and a new cast was applied, from above elbow to the hand.

She still does not want to wear a sling, and is not in any particular discomfort.  I am wondering whether  not wearing a sling was possibly responsible for the wrist not staying straight?  Should I insist she wears one this time?

We are in Samoa, and the options for second medical opinions are limited. Though I think the care she has received has been very good to date.

Thanks,

Kelvin
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When an arm is broken and the fracture is reduced (re-aligned), the arm is put into a cast to hold the arm and the bones in place while it heals.  The biggest danger of an arm in a cast is swelling.  When swelling occurs circulation in the arm may be compromised and there is a danger of loss of the arm.  To reduce the risk of swelling, the arm is not allowed to be held down by the side of the body as blood will flow into the fingers and may cause rapid swelling and a lot of pain.  Use of the arm too soon will also cause swelling, so the arm is put into a sling that will hold the arm up and close to the body for warmth and reduction of use.  If the child is in a sling and the neck hurts, then that tells me that the child is moving (using) the arm.  If continued use of the arm occurs the bones will move inside the case and the alignment may have to be done again. Your child needs to use the sling and keep the arm inactive for at least a month to 6 weeks for healing to occur.  Frequent assessment of the fingers must be done.  The fingers must be moved to keep them supple and if they get cold, you must see a doctor at once as circulation may be in jeopardy.  As children hate having their movements restricted, I can understand that they don't want to use the sling, but for a while the child must cooperate or you will probably be looking at a third surgery.  good luck
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