I know there are many doctors on this board. My 6 years old daughter fell at a friend’s house. We took her to the ER and they found that she has a radial head fracture on the left arm. They are giving us an appointment with an orthopedist for Wednesday or Thursday. From what I saw on the X ray, what the doctor told me and what I read on the web afterwards, I understand that she broke the growth plate. I estimate that it shifted about 40 degres in position (I have no medical background and I may be way off on that one).
Is there anything I need to worry about? Shouldn’t we insist in seeing an orthopedist sooner rather than later?
Actually, there is no giant rush. Although, they are usually ‘set’ in the first 24-36 hours, this is not mandatory. Amazingly, if the reduction is decent, the long term result is almost always good. Compression injuries of the growth plate have the poorest outcomes. These are less common. THis is probably NOT one of those.
If it needs reduction that should be done acutely (24-48hrs), if it just needs a cast and followup then time is not as crucial. not seeing the xrays its kinda hard to know for sure. if the ER doc talked to an orthopedist and described it I am sure you are fine. you could also get the radiologist report the next day and give that reading to the orthopedist you are following up with to know if they want you in sooner. best of luck!
fell off of what, the roof? No aspersions intended there; kids fall. God knows how many times I took spills out of trees or off bikes and deserved to break things. But to the point:
I’m not a doctor, but I had the same injury a year ago: radial head fracture on the left arm. (endo at high speed on concrete). For what it’s worth, mine healed perfectly, and I’m 30, so presumably your six-year old will knit herself together even easier. Only thing is, it really hurts! I mean, really really hurts!
I was in a half-cast and a sling for five or six weeks. After the first few days it didn’t hurt at all in the cast. But then when the cast came off, pain again, especially when extending the arm or rotating the hand. Took a couple weeks to get full range of motion, a month or two to where it didn’t hurt, and maybe three or four months to get back to full strength. But the good news is that now I have to stop & think about which arm it was, there’s no lingering damage that I can perceive.
Best wishes for your daughter’s recovery! I hope she’s right-handed so she can keep up with coloring and ABCs and all.
Two years ago my (then) 9 year-old daughter fractured her tibial growth plate in two places (trampoline).
The pediatric orthopedic surgeon had seen similar injuries twice prior in his career. Both previous cases had permanently stunted growth (the bone stopped growing at that growth plate).
Fortunately, the surgery (two screws in her tibia) worked on our daughter. She is now 11 and while her leg isn’t completely normal, it is the proper length, and she is able to compete at a state level in swimming.
I’m no doctor, but here’s my opinion:
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All orthopedic surgeons are not equal. Get a Pediatric Orthopedic surgeon.
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Time is important. In our case, our initial doctor mis-diagnosed it, and there was a huge rush once the surgeon detected the seriousness of the problem to “get it taken care of before its too late” (I’m not really sure what “too late” meant).
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Don’t be timid. Be very pushy if necessary. Ask questions and don’t settle for half-answers. You are your daughters best advocate - make sure things are being done on her schedule, not the doctors’.
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Your daughter’s situation may be completely different than my daughter’s.
Go see Stefan Klein MD in Watsonville. Great orthopedic surgeon but not just a cutter…a true physician. If it isn’t something he would do based on it being a pediatric case, he will refer to the best in the area.
I believe he has an office in SC, but I know he also has an office in Watsonville. Also, the staff at Stanford is top notch and you won’t go wrong there. Amy Lad is also a top-notch Ortho.
We saw the local orthopedic surgeon here in Santa Cruz and he basically said that she needed to see a pediatric orthopedic surgeon. In the mean time I had emailed the X-rays to my brother who is an ER doctor in the Caribbean. He showed them to a friend of his who is a ped. ortho. That friend is positive that my daughter needs surgery for fracture reduction (The orthoped. she saw today says she has an “angulated fracture of the radial neck”). He also says that the earlier she is taken care off the better. The ped. ortho surgeon that our local ped. surgeon recommends (Dr. Jeffrey Kanel in San Jose) can apparently not see her until Friday!
At this time I am leaning towards taking her tomorrow first thing to the Children’s Hospital in Oakland.
My 4 year-old daughter broke the radial head of her left arm a few months ago. From the ensuing discussion with the orthos, it seems that only a very small difference in location around the growth plate can make a large difference in the prognosis and how the bone heals. I was surprised that the recommendations for how long to cast seemed to vary quite a bit- from 3.5 to 6 weeks. Our ortho recommended four weeks then two weeks of “limited activity”-- not easy for a 4 year-old to accomplish.
FYI, she fell/was fallen on in one of the inflatable jump house/obstacle course contraptions while attending a bike race. She was the youngest girl in her age class (not four at the time) to ride a two-wheeler, and she did it about fifteen minutes after she broke her arm. She felt okay at first, but the pain got worse after a couple of hours.
Never be quick to cut on a Ped. I know you want what is best for your child…everyone has an asshole, er I mean opinion. You need to have some trust in your local medical support - they are not trying to lead you down the wrong path. Doctors are 99.9999% GREAT people who treat all patients like their own family. Calm down, take your time and your child will do great.
Best of luck…it will all work out in the end…quite well I am sure.
40*s of dispacement for a radial head fracture will more than likely require a plate and screws or possibly pinning. Plate and screws are more intricate and take longer in the OR but is generally better on the child as it is internal and never has to be removed. On the other hand, percutaneous pinning is somewhat quick in the OR, less invasive, but the pins are external requiring removal (pulling pins) in about 3-4 weeks. This is somewhat traumatic but truly does not hurt that bad. If the growth plate injury is not repairable, your daughter will likely lose some range of motion in her elbow extension and possibly some range of motion on her rotation of her forearm. I work in an orthopedic clinic and am a tech who scrubs most of our cases. We have done a few of these this year and actually pulled 3 pins today from a 6 year olds left elbow. If you insurance covers it, by all means try and get an pediatric Orthopod. Otherwise, a general orthopedic surgeon can do it. Just does not have the required 1 year fellowship training on working soley on children.
Jason