Fracture, a term used for a broken bone, is a common injury in children because they have bones that are growing and not yet fully developed. It is commonly associated with sporting accidents, falls from furniture, play equipment, stairs, bike and heights. Poor nutrition, a diet low in calcium, and obesity can all increase a child’s fracture risk.
In Nigeria and many other developing countries, falls accounted for 25% to 52% of all treated child injuries in hospitals. The fall can affect any bone of the body, but broken bone is children are mostly the wrists, arms, legs and feet.
Some fractures may require a splint or backslab `(partial cast), held in place with bandages. A splint or cast helps to support the injured area, allowing it to rest and the bone to heal while also providing the child pain relief. Sometimes, a full cast, one that is wrapped around the limb, may be required.
Proper care of the Plaster of Paris (POP) cast starts from the first day. Dr Michael Okunola, a consultant orthopedic surgeon at the University College Hospital emphasized the need for proper care of the plaster cast to ensure the bone heals with less pain.
“They should watch out if there is an increased pain, unusual colouring, numbness and inability to move the fingers or toes in that limb with the plaster cast. Those are signs danger that the cast is tight and the child should be brought back to the hospital so that it can be removed and reapplied,” Dr Okunola added.
He declared that unusual colouring of the skin and sometimes bad smell oozing from the plaster cast is an ominous sign of the limb becoming rotten.
Also, where the plaster cracks, becomes loose or soften if you develop chaffing or soreness of the skin around the edges of the plaster, he declared shouldn’t be overlooked. Adding lotions, powders or oils under or around the cast is also wrong.
Sometimes the limb in plaster case is itchy, especially the first few days after it is applied because of the cotton wool used to protect the skin from the cast. However, he warned against the child inserting a pencil or a stick into the cast to scratch in a bid to have a relief.
“In the process, they can cause injury to the limb by piercing the skin or they can remove the padding. The cotton wool may harden and cause a pressure sore. So, they shouldn’t be tempted to do this; they should bear it. It is just for a short time before the feeling goes,” he added.
Similarly, he stated that letting water seep into the cast could also cause itching and skin damage, including a wound. Also, letting the plaster to be wet can weaken it, make the padding wet and potentially cause a skin or wound infection.
Dr Okunola said the POP cast also is vulnerable to damage, especially about 48 hours after it was applied.
So, it is important not to put any weight or stress on it before it dries. Similarly, the plaster shouldn’t be rested on a hard surface such as the edge of a chair or a table so that a ridge might form. It is best to put a cushion or pillow on any hard surface. Also, when asked to walk with clutches for the leg to heal, they must comply.
Dr Okunola emphasized on proper positioning of the limbs so that the cast does not become tight because of the limb swelling.
According to him, “While the arm is in plaster, it should be elevated at rest especially for the first few days. If allowed to be dangling, it may become swollen causing the plaster to become too tight. That is why they are given a cuff or sling to hang the arm. When they lie down, they should always put the arm on a pillow placed on their chest.
“Also, if the cast is in the lower limb, they should always elevate their leg on the stool when they sit down. It will prevent excessive swelling because even if the cast is not tight initially, there could be tightness and complications can arise from that.”
A common practice is to have people write different things on the cast. “That is allowed, provided it is not compromising the integrity of the cast,” he added.
For children, different colorful plaster casts can also help ensure it is more bearable for them.
According to him, “It makes it appealing, especially to children. But even with that, it is important that instructions given at the hospital be followed strictly. Also, all follow-up appointments should be met to ensure that the bone is healing well and complications can be easily picked and addressed before they get out of hand.”
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