Proximal humerus fracture - part 5

If you need to catch up, you can read part 1, part 2, part 3 and part 4 :)

After two weeks spent with the half-cast on, we returned to the clinic for another appointment. It followed the same pattern as the previous one, with x-rays, a meeting with a doctor, and a visit to the Body Shop.

*

Instead of meeting with the head orthopedic surgeon, we met with one of the residents, which suggests that they're not considering this case all that worrisome. It was actually nice to get a chance to talk to a resident, because he was eager to explain things to us, and willing to go into more details when we asked questions. He suggested that it's possible or even likely that BR did not damage the periosteum around her bone, which is quite encouraging because it should be quite helpful in reshaping the bone and protect the rest of her arm (nerves etc) from the sharp edges of the bone. I have to say I have learned so much about the human bones and their development in the last month than I ever have in school. I guess I am paying a lot more attention now :)

*

The doc told us that we should put the half-cast back on (it was removed for the x-rays), but we should start removing it daily and gave BR some exercises to do without the half-cast to help regain a full range of motion and work on regaining strength and flexibility. And after 3-4 weeks, we would be able to take the half-cast off for good. 

*

BR was super happy to hear that we would be able to re-use the existing half-cast, because she was quite worried about having to deal with another cast setting and heating up. She complained a bit about her arm hurting, but couldn't articulate whether it was more of an itch or a pain, so we figured it was just a bit tight and would work itself out.

*

Our next appointment was scheduled for two months later. That meant that taking off the cast and working on all the physio would have to be done on our own, and she'd be back in school before we saw the doctors again. It's a good news/bad news situation, good because it gives us confidence that things are proceeding well, and bad because we don't really get a chance to ask questions or check how things are going until September.

*

When we took off the half-cast the next day, we discovered that the two parts of the cast had pinched the skin on BRs upper arm. It now had a big bruise and a long cut and was just great for the parental guilt. We covered it up with a bit of ointment and some gauze before putting the half-cast back on. We tried to air it out as much as possible (bandaging up around it), and finally after two weeks it all healed up. It's quite interesting how much slower the skin heals when it's covered up all day and night.

*

And so now you're all caught up. It's been two weeks since the last appointment, we've built up to having the half-cast off for the whole evening without pain or discomfort. BR alternates between feeling better and appreciating the progress she's made and being bored and annoyed at not being able to do things and being asked to take it a little easier. She misses spending time with other kids and having some time away from her parents. But she's a trooper and really we can't complain much about how the last 5 weeks have gone.

Proximal humerus fracture - part 4

If you need to catch up, you can read part 1, part 2 and part 3 :)

Our second visit to the hospital was very different from the first one. For one, we were there less than 2 hours, which went by very fast. It's not surprising, as there was a lot to do:

• got registered at the clinic, 
• waited a bit in the waiting room
• received our requisition to go get some new x-rays
• went to get those done
• came back to the waiting room for a while
• got called into a consultation room
• waited a few minutes more
• met up with the orthopedic surgeon
• back to the waiting room for a bit
• to the "Body Shop" to get a half-cast

The consult with surgeon was quick and slightly confusing, as there was a lot to absorb. We tried to prepare questions ahead of time, but even then we felt like we didn't ask enough questions. The x-ray was still showing the bone very much disconnected and displaced, but the surgeon didn't seem all that worried about it, expecting that gravity will continue to work on it and pull things together.

**

He recommended that we get a half-cast, which is basically a splint made out of plaster, and tied together with a bandage. 

BR was kind of happy to get the half-cast, as it gave her a certain feeling of legitimacy, like she belonged with all the other broken-armed and broken-legged kids. The big arm is definitely more impressive looking than just seeing her arm in the sling. Even her new collar and cuff sling was much more serious looking than the original.

**

The one thing we didn't know or remember about the plaster for the cast was that it gets hot after it gets applied as it sets. I think they don't mention it to the kids to avoid freaking them out in advance. However, in hindsight it might have been a good idea to prepare BR, because she really got quite scared and worried about all the heat. She was ok while the cast was being put on, but afterwards she kept crying and complaining about the heat. I think she was worried it was going to be like that forever. A few minutes later she was visibly relieved as things cooled off.

**

We left the clinic with an appointment set for two weeks later. Things were quite a bit easier with the half-cast, especially the nights and sleeping. The only downside was that BR was a lot hotter with the cast, so we ended up installing a ceiling fan in her room. Our instructions were not to remove the splint for the whole two weeks, and we were worried about BR's skin getting sweaty and itchy, but luckily she only complained about it a handful of times and just blowing into the cast helped. I think a half-cast is much easier to handle from that perspective than a full cast.

**

The shirts and dresses I had prepared for BR the previous week really came in handy with the half cast - we were able to put them on and take them off without disturbing her arm at all, and allowed us to change outfits every day and give BR some variety and a chance to make some choices around what she was going to wear every day.

**

BR's energy was slowly returning, and with that came new challenges. She felt more secure with her arm bandaged up, but we knew her bone wasn't together yet and needed to move down some more, so we often needed to remind her to let her arm hang down, and not jostle it too much. She was also getting bored with the few activities available to her, and looking forward to any kind of new activity. We downloaded a whole bunch of new games to the tablet, introduced her to a bunch of new card games and generally tried to give her some things to anticipate, like birthday parties and picnic lunches.

Proximal humerus fracture - part 3

So as you may have figured out from the titles of the previous posts, the official diagnosis for BR's broken arm is "proximal humerus fracture" on the left side. It's a broken shoulder, the humerus, or upper arm bone broken right at the top. On top of being broken, the bone also moved sideways, causing a displacement of almost 2 cms. Given that BR's arm is not all that wide, it's a big break. Not surprising that anyone who saw the x-ray of the shoulder had a strong reaction.

***

I think all three of us were expecting BR to get a cast before getting discharged from the hospital. We were more than a little surprised to be sent home with just a little sling to support her hand. The idea behind it was to get gravity to pull the arm down and get the bone aligned. A great idea in theory, but quite a hard thing to manage when it comes time to try to sleep. The slightest movement and her arm would start hurting, so the first few nights BR would wake up screaming in pain, and even when she was asleep she would be whimpering and whining in her sleep.

***

BR is generally not a big fan of medication. It's always been hard to get her to take any antibiotics or pain killers, no matter how crappy she might be feeling. Luckily she hasn't required much medication in the past. Even at the hospital, she was not keen on taking the medicine provided to her.

Turns out, a broken bone convinced her of the usefulness of pain killers. By Thursday morning, she was counting the hours until she was allowed the next dose of whichever medication was coming up. We made sure she got a dose immediately before bedtime so she'd get some relief during her sleep, and if she woke up in pain in the middle of the night, we offered her some as well (with varying success). A few days in, she was back to her usual distrust of medication, giving us some hope that her state was improving.

***

The first few days were pretty rough. BR was so quiet and sad, unable to move much, just sitting there. She was a trooper, not complaining much at all, and she appreciated being able to watch TV most of the day. She could not use her left hand at all, couldn't really move (walking down the hall took 15 minutes), didn't feel like eating much. She enjoyed reading e-books, so I bought a few and let her read them on my tablet - but that didn't last long.Thankfully I figured out a way to borrow those from the library, because at 20 minutes per book, it was becoming an expensive habit (kid books are not that expensive, but they are pretty short).

***

When we left the hospital we were asked to book a follow-up appointment at the hospital's orthopedic clinic a week later. Counting down the days to the appointment helped us pass the time, and keep our anxiety in check. DH and I were a little worried about the possible complications in case the bone didn't get aligned (surgery, having to re-break the bone?). We tried not to worry about it too much, but all our googling indicated that this is a fairly rare type of fracture in small kids, and none of the x-ray pictures I found online looked as displaced as BRs. So while we tried to remain positive, we had some nagging worries in the back of our minds. And of course we didn't want to worry BR either.

***

As BR started feeling slightly better, her mood changed too. She was getting frustrated, both with the situation and with us. At the same time as she regained some strength and energy she felt ready to move more, and we had to remind her of her broken bone. She was also getting bored with the limited number of activities she was able to do. Add to it the crappy sleep, and it's no surprise it was a rough week.

***

The one bright spot that week was all the love sent our way by friends and family. BR's class sent her a full envelope of cards and notes from each student. Her teacher prepared her a wonderful bucket full of surprises. A friend dropped by and chatted with her for a little while and they did some crafts together. BR loved receiving flowers and stuffed animals, and she really enjoyed reading all the messages of encouragement in email and on FB.

***

Since moving BR's left arm was out of the question, there was no way for us to remove her t-shirt. Since she was stuck at home all week and barely moving, we decided to keep the t-shirt on, giving her sponge baths from time to time. Finally, on the eve of our appointment at the clinic, we cut open the shirt sleeve and took it off, allowing her to have a full bath. Meanwhile I took a few of her shirts and dresses and opened up their left arm so we could get her dressed and undressed without moving the arm at all.