There may be some swelling of the hand and/or fingers for two to five days after the fracture. Keep the elbow and hand elevated for the first two to three days by lying down on a couch or bed and propping the arm up with pillows; keep elbow and hand above the level of the heart.
Keeping an ice bag on the elbow will also help to reduce the swelling. Ice bags you can use include frozen vegetables such as peas or corn, commercial ice products such as "blue ice," or heavy plastic bags filled with ice. Cover the bags of ice with a dry thin towel to protect the cast from getting wet. If swelling or pain increases, or fingers become numb, notify the orthopaedic nurse or doctor.
Check your child's fingers often for movement, feeling and circulation during the first couple of days following surgery and/or cast placement. Notify your child's doctor of any decrease in circulation, decrease in the ability to move the fingers, or decreased feeling (numbness) in the fingers.
Encourage your child to move his/her fingers.
Keep the cast dry and clean. Waterproof casts cannot be used for fractures with pins in place.
Your child's doctor will order pain medication for you to give your child at home. Follow the directions on the label carefully. If the pain medicine does not work, call the orthopaedic nurse or doctor.
Pin Tract Infection
About 3 percent of patients can develop a pin tract infection. This usually starts about one to four weeks after pin placement. Signs of infection include:
- Increasing elbow pain or fussiness after the first week
- Drainage out of the cast
If your child develops any of these symptoms, call the orthopaedic nurse or doctor.
Baths Only; No Showers
You should place a plastic bag over the casted arm and tape it tight at the top (at the armpit). Never submerge the arm or allow water to run over it. Place the casted arm on the side of the tub and watch the child to make sure he or she keeps the cast out of the water.
If it should get wet, immediately dry with a blow dryer using the cool setting only. If this does not dry the cast, call your doctor immediately for further instructions. A wet cast can cause skin sores if not taken care of right away.
Your child should avoid any activities that may increase the likelihood of tripping and falling. When your child feels well enough and is no longer requiring narcotic pain medicine, he/she may return to school wearing a sling.
Place a safety pin between the two sling layers, just in front of the elbow, to help keep the sling from sliding off of the arm. Your child should wear the sling when out of bed until the cast is removed.
After healing takes place your child may have elbow stiffness that lasts for three to four weeks after the cast is removed. Children often hold their arm for the first few hours after their cast is removed due to elbow stiffness. The stiffness usually goes away spontaneously within a month after cast removal.
Elbow pins are usually removed in the office in a matter of seconds. Although patients may be anxious or cry, it is not a painful procedure, so they need not be scared. We usually place an Ace wrap over the pin sites, which can be replaced with a bandage the next day.
Physical therapy is usually not necessary. Patients are allowed to swim once the skin pin holes have closed up (usually one to two days after cast removal), and your child can play sports once they have near full motion (approximately one to four weeks after cast removal). Return of full range of motion may take up to three months.
Your child's provider will tell you when your child needs to return for follow-up care. Make this appointment at the desk before leaving or call the office as soon as you can to make the appointment.
X-rays will be taken to determine how the healing is progressing.
If you need to reach the orthopaedic nurse before 4 pm Monday through Friday, call 513-636-4567. After 4 pm and during weekends and holidays, call 513-636-4200, and ask that the orthopaedic resident on call be paged.