Broken wrists during isolation: Bike rides gone bad!
Catherine McCutcheon, AHTA Accredited Hand Therapist
When schools were closed, playdates not allowed, and playgrounds roped off parents have had to get creative in finding ways to stimulate, engage and most of all burn energy of our little ones. It is no wonder then that bike sales soared throughout Australia during March 2020 and, with that, a spike in the number of hospital admissions with children coming off their bikes and sustaining injuries. If you were one of those well-intentioned caregivers that started off on a bike ride and ended up with a kid in a cast, if you found the Hospital Emergency Department experience confusing, or if you would like some questions answered then hopefully I can give some clarity to help you know what has happened and what to expect with recovery.
Very simply the forearm consists of two long bones (the radius and ulna), the wrist bones, five hand bones (metacarpals) and the finger bones called phalanges. Children’s bones continue to lengthen as they age. This area of the bone is referred to as the growth plate or physis and can look confusing when seeing it on an xray for the first time. The bone matrix of a child differs to an adult allowing it to have more bend and making it able to tolerate greater force before it breaks.
A common injury for children to sustain when they fall off their bike is injury to the end of the radius bone or to have a ‘broken wrist’ which will be the focus of this article. The doctor or nurse may use the word ‘fracture’ which means a broken bone. In fact, the words ‘fracture’ and ‘broken’ can be used interchangeably. Children’s bones are more flexible than adults’ bones and can even bend as well as break. This can result in some partial breaks in the bone which are called ‘greenstick’ and ‘buckle’ fractures).
After correct anatomic positioning and stability is achieved the wrist will require immobilisation and protection to ensure the fracture is kept still while it heals. Commonly a plaster or synthetic cast is used, however for stable fractures a more light-weight, waterproof, breathable thermoplastic orthosis may be used.The doctor may use the words stable, unstable, displaced or angulated to describe your child’s fracture. This describes the position and severity of the fracture and will determine if the fracture needs to be manipulated back into the correct position, if it is stable and safe to cast as it is, or whether it may require surgical intervention.
Children typically heal well and tolerate casts very well and when healing is evident the cast is removed. Often the child will be a little stiff and require some exercises to regain full movement of their wrist, forearm and maybe the fingers and thumb. It is also normal for the strength of the hand and forearm to be reduced. The cast is most commonly worn for four to six weeks, however if your child is particularly talented in the art of falling off their bike and has sustained multiple fractures or a more severe single fracture then the cast may be required for longer.
Practitioners of hand therapy are trained in the management of fractures, cast fabrication and rehabilitation programs. We are able to assist at any point without a referring doctor. If you have any further questions or enquires about hand and upper limb fractures or injuries then let us know so we can get some information to you.
I hope this has made things a little clearer for you all. Happy riding folks!