My grandson broke his wrist 10 days ago. Since then the cast has come off 4 times. Two trips back to the hospital to have it re-cast and twice back to a special pediatric center. Each time a different person put the cast on. 3 of the casts were up past the elbow. We have heard that it is not unusual for casts to come off on young children. I'm thinking that one might tape the cast up so it can't come off again. Has anyone heard of this? Is there a solution?
Unfortunately, in very young children, they have very chubby arms, with little places to mold a cast around. So, in these children, the cast has to be a long arm cast, up into the armpit, and the elbow bent at 90 degrees, or it will be off the child before the family gets to the car in the parking lot.
Luckily, in a two year old, the fracture will be healed in a very short amount of time.
We usually placed very small children in a modified Velpeau sling, using stockinette, basically tying the forearm to the chest with a special type of sling that goes around the neck. But, it has to be put on by someone familiar with the technique.
Another technique used in casting small children, is to use tincture of benzoin (which is a sticky substance) on the skin before wrapping the cast padding. Thus the cast doesn't slide. But, you do have to be careful not to put too much on.
Unfortunately, younger orthopedic surgeons do not get the training in casting, since so many fractures now days are treated surgically. So, the older surgeons and technicians are the ones to get to put the cast on little kids. They know all of the old tricks of the trade.
Again, kids usually heal very quickly. Unless it was a totally displaced fracture, the child may not need a cast for very long. In most cases of torus (buckle) fractures, a cast is not even really needed. The child will decrease his/her activity and protect the arm, till the tenderness goes away (usually in just a few days). Minimal torus fractures are stable fractures that do not displace. They occur in children because their bones still have a large component of cartilage in them. So, the small child's bones will buckle, rather than snap in two, like an adults. We tend to put casts on the minimal buckle fractures more for the parents, than for the child.
But, if the child still needs a cast, contact the pedi-pod (pediatric orthopedist) to see if the child can be put in a modified Velpeau sling, so the cast doesn't come off again. This will really tie the child up, and some kids really don't like it. They may have a real tantrum. And children are Houdinis, they can get out of just about anything you put on them. So, be prepared for a struggle.