Sprains vs. breaks

Todays' topic (brought to you by my older son at recess two days ago):

1. Sprain vs. break

2. How growth plates in children make it difficult to read x-rays so you're very lucky if you live in a place with an awesome children's hospital

3. Ibuprofen for a sprain but acetaminophen for a break (medical research = fascinating)

4. Is it easier to get around your elementary school using one crutch or two?

 

(Diagnosis: Sprain. But if it doesn't feel better in two days they're re-x-raying.)

 

All comments on children's injuries and the process of dealing with them solicited.

Comments

[laura]

Comfrey (as a salve, ointment, or just the infused oil) helps heal sprains and breaks. Arnica is nice for swelling and bruising.

[My Kids Mom]

Both times my son has had breaks I'd ignored them the night before. By morning my usually non-complaining son was not only sporting very swollen and purple areas but also crying at the prospect of removing pj's. Both breaks were in growth plates (pinkie finger and elbow) and both required more cast than I expected. The elbow required weekly x-rays with the warning that it would require surgery if not healing completely straight.

Be sure to pay the extra for a waterproof cast. WORTH IT!

[Joanne]

Sorry to hear that your son hurt himself. I don't have any advice on your questions, but would like to pose one of my own. (Perhaps it is a question for another day.) Is it common for girls ages 8-9ish to be constantly complaining of every ache and pain under the sun? I'm starting to think my daughter's a hypochondriac, and I'm fearful that the school nurse is going to think we're abusing her. Every little injury gets blown WAY out of proportion. It makes it very hard to know when she's actually hurt. Is this normal? I'm starting to wonder if it's time for her to see a therapist because I fear she's using aches and pains as a tool to get attention (which baffles me because I feel like we're quite attentive for the most part).

[Heather]

Sprain --- watch for rehab needs. Don't let the body decide that the "new" situation is better than the old one.

Example - I sprained a ligament in my foot THREE YEARS AGO, rest and advil made me think it was getting better. Have perpetual weak spot there that gets chiropractic attention and makes me put away my cute shoes and replace them with tennis shoes.

Good luck!

[Meg]

Sprains can be worse than breaks. Definitely look into physical therapy if it is a sprain, it's the only way they get better, says the woman who has torn all the ligaments in her right ankle, and then re-sprained it a few years later.

[Carla Hinkle]

Surprisingly I have some very recent experience with this.

My oldest (8) broke 2 bones her her foot on Labor Day Weekend just stepping wrong off a step. She cried a little when it happened but honestly not THAT much. She was limping around but not REALLY complaining so I thought it was just a twist/sprain. (I even sent her to karate! Ah!) But 5 days later I finally took her to the ped and lo and behold, she had broken the 4th and 5th bones in her foot.

So I guess my conclusion is, I thought it would be very, very clear if a kid had a broken bone vs a sprain/twist/etc, but apparently not. She has been able to do the pneumatic (air-filled) rocker boot instead of a cast which is a total lifesaver. She doesn't need crutches at all. And initially (after seeing the ped but before the ortho) when she had just a hard shoe sort of thing instead of the boot, she had to use crutches and it was a huge PITA. Though she did say 1 crutch was too hard to use, she kept tipping over, it was 2 or nothing.

So, any chance of a boot and no crutches? I'm not sure how ankle vs foot plays out in that decision. Sorry your boy is injured!

[Moxie]

I asked about a boot right away, and the sprain is in the wrong place. We'll see how he's doing with the crutch today...

[flea]

In our experience of a break - fell off the monkey bars in 1st grade, jamming thumb - it was instantly clear that it was probably an x-ray worthy injury. Lots of swelling, hurt a lot. Called the ped., they sent us to the (small town) ER, where they x-rayed and splinted and recommended an orthopedist, whom we saw the next day. They re-x-rayed, were concerned about the growth plate at the base of the thumb, and did a cast. Luckily it was the non-writing hand, the pain was negligible after the first few hours passed, and the thrill of a cast made the patient all the rage at school. All in all, if you have to break a bone, this is the way I'd like it to happen.

[QoB]

Crutches: pad the hell out of them with two or three thick sports socks on the handles. Get him to wear a hoodie with a pocket so it's easier to carry things around (plus a backpack, if it's not too heavy it's manageable).

Personal experience with breaks -v- sprains; the sprains resulted in more spectacular swelling, but the break had the best (darkest, most instant, most lurid, and most extensive) bruising. I also echo the other commenters about getting physio once it's healed as one ankle has a smaller range of movement now from sprains that I let heal by themselves and never got a physio consult on.

Either way, he will be fine and will have a quality story to tell :)

[Kathy B]

I have no experience with sprain/break issues; I am, however, a pro at stitches.

[Jan]

Second the recommendation for a waterproof cast. And a tip: if you choose a dark color, nobody can sign it, which as far as I can tell is the only fun thing about having a broken anything.

My husband broke his toe recently and was told not to take ibuprofen, too. This was new information for me -- what's the science behind it?

[Asterisk]

Mine (5) broke a wrist in an awkward monkey bar landing and there was no mistaking the injury for anything else - the hand just dangled there.

Thumbs up for the pediatric emergency ward that evening, but the wait at the fracture clinic the next day was trying. Luckily the break (to the smaller wrist bone) was not on a growth plate, and the cast was on for just three weeks. Acetaminophen was prescribed.

[Alexicographer]

Oof, no words of wisdom, only sympathies, for both of you. @MyKidsMom, my mom let my brother go maybe 2 days before seeking care for what turned out to be a broken arm, and she's far from the neglectful sort (I forget details, but obviously for whatever reason she didn't realize ...). It happens.

[Alexicographer]

Here's some info. on the sprain/break NSAIDs question, for those interested: http://www.musculoskeletalnetwork.com/display/article/1145622/1870518 .

A quick excerpt from the conclusion reads, "Although evidence suggests that long-term use of NSAIDs for managing fracture pain and inflammation carries the risk of impaired bone healing, the use of NSAIDs for shorter periods probably would have little impact on the overall healing process. Therefore, these medications may still be of benefit in patients who cannot take other types of analgesics.

In tendinopathies, where inflammation plays a lesser role, NSAIDs probably have little influence on healing and may be of some benefit as a limited short course for analgesia. With sprains, strains, or tears of ligaments, NSAIDs may be of more use by limiting the pain and swelling of these injuries, increasing patients’ chances of regaining function and returning to activity sooner. Studies have shown some value in this therapy when used for short periods (3 to 7 days). Evidence also supports the short-term use of NSAIDs for the management of muscular injury, providing some pain relief and allowing for earlier resumption of normal activity."

[Christine]

I don't speak much of our broken bone experience because we're still traumatized a year out. But one thing I learned that I hadn't expected: fractures in children can affect the growth of the bone long term (and Julia didn't break her leg at a growth plate). We're monitoring, but her legs aren't the same length and if it gets worse she may end up in traction for months as a teenager. I barely survived the demon spica cast. I hope it's a sprain.

[Wilhelmina]

Being hyper-mobile I tend not to break bones because the ligaments give way first. Which is a good thing, but I have learned the hard way that the body compensates really easily for soft tissue injuries.

No conscious awareness, but you will use the injured area less and change the pattern of using the area and putting weight through it for the long term.

I wound up with one leg much weaker and thinner than the other after bad ankle sprain. Physio put all that right but it's easier to check early on that all is well and that you can put weight on both legs.

Sympathy for @ Moxie and son. Whether break or sprain it's hard. And crutches. I second padding them!

[Alexicographer]

Also, no one's addressed this yet and I have not (yet) acquired direct expertise, but I'm told forearm crutches are way better than the underarm ones in virtually every way imaginable. No idea if that's true or not, and it may not matter too much if the crutch use is just for, say, a week, but I am always mystified by the prevalence of underarm rather than forearm crutches, given what I've been told by those who have used both.

[Dana]

Joanne, I can't speak to the question of girls and hypochondria from a parental standpoint, but I did the same thing around that age. In my case, it was largely boredom and frustration with school. Sheer boredom gave me time to focus on whatever aches or pains I could find (or conjure up)and really convince myself I was hurting or ill. And my hatred of the classroom I was in was cured by a trip to the nurse's office and maybe even being sent home. So it was a winning strategy until my father let me know that he wasn't going to play along with picking me up from school for fake illnesses. Although I vehemently denied that I was faking, I knew the jig was up and didn't really play the fake injury/illness card again. Or at least not as often.

[yasmara]

I've had several bad sprains (torn ligaments, etc.) in my left ankle & due to inadequate physical therapy (aka none), I have about 3 inches less flexibility in my left ankle than my right.

In each sprain, the dr said I would have been better off (in terms of future joint stability, etc.) w/a break than a bad sprain.

So, keep a close eye on it & don't be afraid to ask for some rehab exercises. If no/inadequate rehab is done, that joint may be much more vulnerable to future re-injury/re-spraining.

[JH]

My daughter fell from the monkey bars, broke her elbow, and had surgery just 3 days before her first day of kindergarten this past August. I was glad that there was no mistaking that the bone was broken and the extent of the break because it left no doubt as to what was the right thing to do to fix it. She had a miserable first few weeks at school, but things have improved since she got her cast off (it was only on for 3 weeks and no physical therapy). I do, though, think she has a bit of PTSD as a result. She now thinks every bump and scratch means a trip to the hospital and she tenses up and panics every time she hears or sees an ambulance. She's always been on the anxious side, but this is a whole new level (sleep troubles; increase in nightmares; separation anxiety). Anybody else have kids who became increasingly anxious after bone breaks or other significant injuries? What helped?

[Megan @ Mama Bub]

Ugh. My son broke his leg when he was TWO, and we made the mistake of going to urgent care instead of the children's hospital (because we didn't think it could possibly be broken.) So stupid. Urgent care doctor said as soon as he was splinted, he wouldn't feel pain. He was so wrong. He also told us it was his knee, not his leg that was broken. The lesson? If you have a children's hospital, start there.

[Wilhelmina]

@JH yes! My daughter now nearly five had a near fatal, blue light to hospital in the ambulance, anaphylactic shock. Which is not a broken bone of course. But adults describe a sense of doom with anaphylaxis.

Even though she was basically completely pre-verbal fear of hospitals, ambulances and injury set in very rapidly and persisted.

Definitely had sleep disturbances, and separation anxiety and lots of difficulties going to sleep.

She's much better now in terms of medical stuff but the phobia's not gone by any means.

Doing Social stories type books for medical treatment has helped. Finding a great dentistry practice working with phobic children helped a lot. Making sure you always see the same staff if possible.

Toys helped, toy ambulance for her stuffed toys and getting a baby doll for her to comfort also have helped a lot. Increasing verbal ability, not an issue for you with a Kingergartener also helped by being able to talk about things.

But it definitely changed her. From other mothers in the allergy group there seems to be a great similarity in the children who had the ambulance with siren anaphylaxis and the ones who didn't. More cautious.

But nothing near as scared and upset as in the 18 months after the episode.

[Christine]

@JH, definitely. My daughter still has a lot of issues after her break. She didn't have an ambulance ride because my husband didn't realize her leg was broken so he brought her home. I knew it was broken but we live 2 minutes from the hospital so I just took her over in our car. But she talks a lot about everything that happened and reenacts it with her dolls. She's not afraid of her ped, who we didn't see, but she is afraid that she might be left alone at the hospital (she was not, until they took her back into surgery). She will complain that one of her legs hurts and ask for a "cast" and I'll put an ACE bandage on for her. She was very thrown by seeing one of her classmates in a wheelchair this week. She's still triggered pretty easily.

[Alexicographer]

@JH we didn't have an experience like yours, but, you know, doctor visits, not fun for little kids -- DS had endured little more than standard shots + a few ear infections, but wasn't fond of going to the doctor (go figure). I was weirded out (in a good way) by how reassuring he (then 3?) found it to go with me one time when I had to take a dog to the vet (for an exam of an internally injured leg -- think, sprain -- so unpleasant for the dog who is himself a nervous (but gentle) soul, but not gross or deeply traumatic for anyone, dog included). I took him (my son) along in desperation only because I couldn't arrange a sitter, etc., etc., but something about seeing the dog being examined by a doctor (vet) seemed to help DS get the idea that doctor visits is one of those things and that we all go through it at some time or another. I've also tried to be outspoken about the times DH and I are going to the doctor for one reason or another (we've had a few major things -- I broke an arm badly -- and a bunch more minor), again to convey the message that this is "one of those things." For else (and again, admittedly from a very different starting point) it seems to have helped.

[laura]

reading all these comments makes me realize I should probably get my ankle looked at by a PT. I rolled it on a hike in late July and added some minor damage with an awkward step a couple weeks ago. It is not healing up the way it should and I need to trust my gut on that.

Thanks everyone!

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