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Arm Fracture
Fractures or broken bones are common childhood injuries due to increased activity levels and growing bones.
The most common sites of childhood fractures are wrists, arms, elbows and ankles, which usually occur after a fall.
Treatment
After the Cast is Removed
Pain Relief
Returning to Normal Activities
Treatment
If a child breaks a bone in their arm, they may have a plaster cast to protect it whilst it heals. Your child’s treatment will depend on where their fracture is. They may also require surgery.
Your clinician will explain which treatment is best for your child’s fracture. Broken bones heal quite quickly in children so they usually only have to stay in cast for 4-8 weeks. The cast will be removed once the fracture has healed.
Read: How to Care for your Plaster Cast
After the Cast is Removed
Once the cast has been removed, it is normal to experience some changes in your arm such as
- The joints feeling stiff
- The arm being slightly smaller than the other side
- Swelling may come and go
- The skin being dry, flaky and sometimes having changes in hair growth
- Your arm will be weaker.
Pain Relief
Initially once the cast is removed it is normal for your child to complain of aches and discomfort when using that arm more. These should be easily managed with adequate pain relief.
See NHS 111 Wales guidelines here on pain relief.
Speak to your local pharmacy about appropriate pain relief for your child.
Returning to Normal Activities
Children normally regain strength by using their arm for gentle activity and play. Encourage your child to return to normal activities once the cast is removed as this is the best way to regain strength and normal function of that arm.
When the arm is not being used, your child should try to elevate it to help reduce swelling. Avoid letting it hang down by your side for too long initially.
Your clinician will give specific advice about returning to sport, which in most cases may be resumed four to six weeks after the cast is removed. However this is different for each child, and dependent on factors such as whether your child required surgery first.
Exercises
Range of Movement Exercises
Gentle range of movement exercises can be encouraged as soon as the cast is removed as well as encouraging your child to start to use that arm in their daily activities. It is normal for them to favour the other side initially as they are used to the injured arm being immobilised whilst in the cast.
Range of movement of all joints of the injured arm should be completed little and often throughout the day.
Below are some movements to encourage with children once their cast has been removed to reduce stiffness, swelling and start strengthening their arm muscles.
Shoulder Flexion
- Stand up straight with arms by your sides.
- Lift one arm forward and up with the thumb leading the movement.
- Lower the arm back to the starting position.
Elbow Flexion and Extension
- Bend your elbow and assist the movement with your other hand if needed.
- Straighten your elbow.
Wrist Flexion and Extension
- Starting with your wrist in a neutral position, bring your palm down towards your wrist.
- Then straighten it back up.
- Repeat.
Radial and Ulnar Deviation
- Rest your arm and hand on a table.
- Hold fingers and wrist straight.
- Bend wrist first towards the little finger and then towards the thumb
Supination and Pronation
- Place forearm on a table with the palm turned down.
- Alternatively turn palm up and down keeping elbow still.
Hand Exercises
Encourage play with playdough, putty or slime. This will encourage grip strength and improve hand dexterity.
Wrist and Arm Stretches
Below are some examples of wrist and arm stretches. Hold these positions for 30 seconds, and repeat 3 times daily. Your child should feel a slight stretch/pulling feeling but it shouldn’t be painful.
Resistance Exercises
Once you have gained full range of movement in the injured arm and your physio has assessed your movement, you can progress to strengthening your arm with the following exercises.
Throwing and catching
Below are some examples of throwing exercises that you could complete. Complete 12 repetitions and 3 sets of each.
- Hold a ball and bounce it on the floor
- Hold a ball and bounce it on the wall
- Throw a ball into a basketball/netball net
Elbow extension with theraband
- Lie on your back, squeeze your shoulder blades together and keep them in this position for the exercise.
- Bend your elbow and hold on to the theraband.
- Ask your parent/ carer to stand at the top of the bed and hold the theraband taught.
- Slowly straighten your arm, pulling the band down towards your feet, then slowly bend your arm to get back to your start position.
- Complete 8 repetitions, 3 sets of each.
Elbow flexion with theraband
- Lie on your back, squeeze your shoulder blades together and hold this position.
- Start with your arm straight by your side.
- Ask your parent/ carer to stand by your feet holding one end of the theraband, whilst you hold the other end.
- The band should be taught in this position.
- Bend your elbow, then straighten your elbow back to the start position.
- Complete 8 repetitions, 3 sets of each.
Weighted active movements
Complete the same movements you did for ‘range of movement exercises’ but with a light weight. For instance a tennis ball, tin of food or bottle.
The weight can be progressed as able within your comfort zone. Complete 12 repetitions and 3 sets of each.
Wall push up
- Stand facing the wall with your palms at shoulder level and slightly wider than your shoulders.
- Start with your elbows straight, lean in to your arms and slowly bend your elbows to bring your chest to the wall.
- Then straighten your arms to get to your start position.
- Complete 8 repetitions, 3 sets of each.
Superman
- Start in a crawling position with your hands directly beneath your shoulders, and knees directly beneath your hips.
- Lift one arm up until your hand is level with your shoulder.
- Hold you arm here whilst you lift the opposite leg behind you.
- Push through the arm on the floor and try to keep your torso level.
- Draw in your tummy muscles to prevent your back arching.
- Hold for 5 seconds then relax.
- Complete 8 repetitions, 3 sets of each on each side.
If you have any concerns or queries about this information please contact Dolphin Outpatients on 02921 847577.
If your child does not have an appointment arranged with physio and symptoms continue or are not improving gradually, then you can self-refer your child to the Paediatric Physiotherapy Outpatient Department by telephoning the our referral line on 02921 836908.
The Coral Reef Outpatients Department is open for plaster problems from Monday – Friday, 08:15 – 15:30. Contact 02921847991 or 02921847569
Outside of these hours please contact the emergency unit on 02920748018 or 02920748094
University Hospital of Wales, Heath Park Way, Cardiff, CF14 4XW
