Your child recently had an orthopedic injury. They have sprained their ankle or broken their wrist. They’ve gone to the physician and gotten a treatment plan. Now, it’s time to go home. But what do you do now?
The original trauma and pain may be over, but your child may not be completely healed — especially if they have received pins, a cast, a splint, or crutches.
After-pin care, casts, splints, and crutches require careful use and supervision. If not used correctly, your child may have a slower healing time or an increased risk of reinjury.
The orthopedics team at Children’s Hospital & Medical Center will work with you and your child to make sure that you know how to use and care for everything correctly. We have also put together these general guidelines for after-pin care, cast and splint care, and crutch use.
After-Pin CarePins are often used to keep a fractured bone in place as it heals. They may be used alongside splints and casts.
In some cases, they need to stick out of the skin in order to keep the bone in place. It is very important to keep this area clean in order to prevent infection.
- Remove current dressing after 12 hours.
- Cover wounds with bandages until drainage has stopped.
- Keep he wound dry for at least 1 day (no showers).
- Wait 5 days before submerging the wound in water (e.g., bathtub, swimming pool).
Even with the pins, your child’s fracture is still healing. During this time, it’s easy to re-injure the bone.
Here is how you can help your child avoid re-injury:
- Encourage gentle range of motion exercises. This includes extending and flexing the injured joint at least 3 times per day, until the motion is the same as the uninjured side.
- Do not use anything with wheels, such as bikes, rollerblades, or skateboards for at least 3 weeks.
- Avoid activities that involve jumping, such as using swing sets, jungle gyms, diving boards, or monkey bars for at least 3 weeks.
- Do not participate in gym class for 3 weeks.
Even after the injury has healed, your child should avoid using trampolines. Landing the wrong way on a trampoline can cause serious, permanent injuries.
After the pins and cast have been removed, your child may be sore for several days. This
soreness may be treated with Tylenol or ibuprofen.
Call your child’s physician or the Children’s Orthopedics Department if:
- Drainage from the wound continues more than 5 days after pin removal.
- Your child has a temperature of 101° F or higher.
- There is an odor around the wound.
- The pin sites or incision become red, swollen, and tender — or open.
Call 402-955-6300 for any questions or concerns.
Cast And Splint Care
Why Casts And Splints?
Casts and splints protect bones and soft tissue after an orthopedic injury or surgery.
Casts are made to fit and stabilize the affected area in a specific position. A cast can be made of plaster or fiberglass, depending on the physician’s preference. Cotton or synthetic padding inside the cast provides protection and comfort while the cast is in place.
Splints are often described as “half-casts.” Splints can either be custom-made or ready-made. The ready-made ones are easier and quicker to use, come in a variety of shapes and sizes, and have Velcro straps, which makes it easy to take the splint on or off and adjust it.
While Wearing A Cast Or Splint: Itching And Swelling
The cast or splint is itching. Yes, that’s annoying and uncomfortable, but do not place anything inside of it. This could cause injury or infection. You can help your child reduce itchiness by using a hairdryer on a cool setting to blow cool air into the cast or splint.
Swelling — especially in the fingers — is common within the first few days after getting the cast. To relieve swelling, elevate the injured area above your child’s head. Encourage your child to move their fingers and toes frequently to help reduce swelling and prevent stiffness.
If excessive swelling is causing severe pain, numbness, tingling, or burning of their fingers or skin, contact your child’s physician immediately. These may be signs that the cast or splint is cutting off circulation to the hand or leg, which can cause long-term nerve damage or blood flow problems.
Your child’s physician will provide instructions on activities that can be done while in a cast or splint. If the leg is injured, the physician will also let you know if your child can bear weight on the leg.
In general, have your child avoid sports, gym class, recess, and other activities that involve wheels or motorized equipment (e.g. bicycles, rollerblades, scooters). This helps avoid further injury to your child and other children, and protects the cast or splint.
Never attempt to remove a cast on your own. Your child’s care team will remove the cast safely with a cast saw.
The cast saw vibrates, and may feel warm from friction as the saw blade moves through the cast. It is also loud, which may cause your child to be slightly anxious when the cast is being removed. Reassure your child that even though the noise is loud, everything’s fine. It will be over soon, and they can say goodbye to the cast.
To heal the injury with a splint or cast, DO NOT…
- Get the cast or splint dirty and wet. Moisture in the cast can cause skin irritation and a change in the position of the cast padding. If the edges of the cast become damp, use a hairdryer on a cool setting to dry the cast. If the cast becomes very wet, contact your child’s physician. The cast may need to be replaced.
- Let your child scratch the skin under the cast by putting objects into the cast. This can cause skin damage, infection, or a change in the position of the cast padding. If your child does put something inside of the cast to scratch it, let the physician know immediately. The cast may need to be replaced.
- Remove any padding or lining from the cast.
- Put powders, lotions, or oils inside the cast. That could irritate the skin.
- Let sand, dirt, or gravel get into the cast. It’s helpful to keep leg casts covered with a sock or slipper.
- Attempt to remove any part of the cast.
- Keep the edges of the cast rough. Rough edges can be gently filed smooth with a nail file or covered with moleskin, which is available at most pharmacies.
- Let the cast develop soft spots or cracks. If this happens, contact your child’s physician right away.
If your child is using a walking leg cast, they will need a cast shoe — a sandal-like shoe designed to protect the cast and help your child walk. Always make sure your child is using the shoe. Otherwise, the cast may rapidly deteriorate and need to be replaced.
Contact Your Child’s Physician If They Experience …
- Increasing pain that is not relieved by elevation, rest, and pain medication prescribed by the physician.
- Numbness, tingling, and burning that is persistent and not relieved by elevation or rest.
- Areas of persistent pain or pressure caused by the cast.
- Loss of movement or feeling of fingers or toes.
- Drainage from the cast after surgery.
Casts are made of a synthetic water-repellent padding material and a fiberglass outer shell designed so that your child may get the cast wet, if the physician allows.
The outer part is fiberglass, which means that the cast is light, strong, and water resistant. The combination of these materials allows your child to shower or bathe without having to wrap the cast in a waterproof cast cover.
Cast Care — Wet Use
- If the physician permits your child to get the cast wet, allow the cast and your child’s skin to dry thoroughly before getting the cast wet again.
- Drying time for casts will vary. In some cases, weather conditions, perspiration, or cast construction will prevent the cast from drying completely. Most casts will feel comfortably dry in 1 to 3 hours. If the cast feels wet longer, stop getting the cast wet.
- If your child experiences softened, white, or wrinkled skin, skin irritation, heat rash, or pain, do not get the cast wet.
- Monitor the condition of the cast and skin under the cast after your child has gotten the cast wet. If the cast is not drying, do not allow them to get the cast wet again.
- If you use a blow dryer to help dry the cast, only use a cool setting.
- Gravity causes the water to drain from the cast. If the cast is wet, it is important to position the cast so that water will drain out. If the cast will not drain, do not get the cast wet again.
- For an arm cast, hang your child’s arm downward and drain from the end of the cast.
- For a leg cast, tilt your child’s toes downward to allow cast to drain from toe area. Or, you can have them elevate their leg and let water drain from the other end of the cast.
- Have your child avoid swimming in natural bodies of water, such as lakes, rivers, and oceans. Waterborne parasites or contaminants can enter the cast, and may cause skin irritation or other problems.
- Rinse out the cast thoroughly with clean water after swimming, showering, or bathing.
- When your child is swimming, have them avoid deep water.
General Cast Care
All casts require certain general care, regardless of whether they are wet or dry. In order for the cast to be effective, follow these instructions carefully:
- Keep the cast or splint clean and dry. Moisture in the cast can cause skin irritation and a change in the position of the cast padding. When bathing, protect the cast with plastic bags and elevate it out and away from the water. Commercially made cast covers are also available and can be purchased from various vendors. If the edges of the cast become damp, you may use a hairdryer on a cool setting to dry the cast. If the cast becomes very wet, contact your doctor. The cast may need to be replaced.
- Do not let your child scratch the skin under the cast by putting objects into the cast. This can cause skin damage, infection, or a change in the position of the cast padding. Objects permanently stuck inside a cast can cause a pressure sore. If your child does put something inside of the cast to scratch it, let the physician know immediately. The cast may need to be replaced.
- Do not remove any padding or lining from the cast.
- Do not put powders, lotions, or oils inside the cast, as they may irritate the skin.
- Protect the cast from sand, dirt, and gravel. It is helpful to keep leg casts covered with a sock or slipper.
- Do not attempt to remove any part of the cast.
- Rough edges can be gently filed smooth with a fingernail file, or covered with moleskin, which is available at most pharmacies.
- If the cast develops soft spots or cracks, contact your child’s physician right away.
Gait Training: Using Crutches
How To Walk With Crutches
Walking with crutches is a bit more complicated than it looks. We will teach your child how to use crutches correctly. But when you’re at home, make sure your child follows these instructions in order to use their crutches safely and effectively:
- Put crutches under the arms and press them against the body.
- Bear weight on the hands, not under the arms.
- Have your child place the crutches ahead of themselves by about a foot. Then, they should push down on the grips of the crutches as they step slightly past the crutches, leading with the uninjured leg. Repeat.
- Have them move slowly at first until they develop a natural, comfortable pattern.
The crutches may be a little uncomfortable, but they should not cause any numbness or tingling. If your child complains of these symptoms in their armpits or upper arms, make sure they are using the proper walking technique, as demonstrated by their physician, physical therapist, or athletic trainer.
Sitting Down And Getting Up With Crutches
In order to sit down with crutches, have your child:
- Stand with the chair about 2 to 3 inches behind their legs.
- Put both crutches in the hand of their injured side while reaching backwards for the chair with the other hand.
- Lower into the chair, bending at the hips.
Getting up is simply reversing the process. To rise from a seated position, have your child:
- Put both crutches in the hand of their injured side.
- Slide to the edge of the chair or seat.
- Push down on the arm of the chair on the uninjured side.
- Stand up, and then put the crutches under the arms.
- Press the arm pads into the body.
Going Up And Down Stairs With Crutches
Your child’s physician may advise you to have your child avoid stairs while on crutches. But since completely avoiding stairs isn’t always possible, it’s important for your child to know how to climb stairs safely.
To go upstairs, have your child:
- Start close to the bottom step, and push down on the crutches with their hands.
- Step up first with the uninjured foot, then the injured leg, followed by the crutches.
Walk behind your child, in order to provide support.
To go down stairs, have your child:
- Start at the edge of the step, keeping their hips beneath their body.
- Place the crutches on the step below, followed by the injured leg, then the uninjured leg.
- Be sure to bend at the hips and knees to prevent leaning too far forward, which could cause them to fall.
- If a handrail is available, place both crutches in the hand of the uninjured side, and place the hand of the injured side onto the rail. Advance their hand on the rail slightly as they place the crutches on the lower stair.
Walk in front of your child, in order to provide support.
Helping Your Child Use Crutches Safely
- Secure the arm pads and hand grips before use.
- Tighten all hardware (screws and wing nuts) at least once per week.
- Clean pebbles or dirt off of the bottom of the crutches to reduce the risk of slipping.
- Assist your child with the crutches until they have shown that they can use them on their own.
- Remove loose rugs and electrical cords from all potential paths to avoid tripping and falling.
- When standing on crutches, place them a short distance in front of the feet and lean forward slightly.
- Make sure your child never stands with the crutches even with their body, as they can easily lose balance in this position.
- Keep body weight on the wrists and hands, never the underarms.
- Have them wear their backpack on both shoulders.
- Always have them wear shoes, and never slippers or flip flops, as these will affect balance.
- Use the crutches as prescribed by the physician.
- Do not attempt to bear weight on the injured leg until told to do so by the physician.
What To Do Next
If you have any questions about post-injury care or to set up a follow-up appointment with your child’s orthopedic care team, please call us at 402-955-6300 or 402-955-PLAY (7529).