Upper Limb Injuries
- Humeral Brace Fitting
Humeral brace is a support that is commonly used for upper arm bone (humerus) fractures. It helps to splint the bone and stops movement of the broken bone, which can cause severe pain. It also helps to keep the bone in good alignment while it is healing. As it snuggly fits around the arm, it is important to take proper care of the skin underneath to keep it healthy.
You have to use the brace all the time initially. You should not remove the brace by yourself unless instructed to do so by the Consultant. However, you may be instructed to loosen or tighten the straps depending on the swelling of your arm. The brace should fit firmly to your arm but not too tight.
It is important to keep your brace clean and dry when you clean your elbow crease or armpit. If you wear a damp brace for a prolonged period of time it can cause damage to your skin.
In the first few weeks when it is too painful, we will bring you to the plaster room for the skin care and to teach you how to remove the brace and reapply once the skin is taken care off. When the pain eases off, it can be taken care of by yourself. You will be provided with a contact number for the Fracture Clinic Plaster Room if you have any concerns like pinching of the skin, rash or irritation to the skin.
- Distal Radius Cast Management
You will be put in a forearm cast when you have injuries around our wrist. It helps to splint and rest your joint while healing.
You should keep your cast clean and dry. If the cast gets wet, the padding will get soaked and it can macerate the skin if left unattended. If you have a cast following surgery it can cause infection to your wound. You may try using a hair dryer on a luke warm setting to dry the plaster if it gets wet accidentally.
It is important to keep your forearm elevated to prevent the swelling from getting worse.
You are encouraged to move and exercise your fingers and elbow to prevent stiffening of the joints.
If at any point, you feel the cast very is tight and painful you should contact the Fracture Clinic during working hours or attend the Emergency Department to have the cast split open.
If you have any other problems like the cast becoming too loose or tight, irritation to skin, constant pins & needles or numbness, smell or discharge underneath the plaster, you should contact the Plaster Room for further assistance.
In case of persistent or severe itching to skin, do not insert anything sharp or blunt inside your plaster as it may cause damage to your skin. Instead contact the Plaster Room for it to be looked at.
You should not drive when you are in a cast. Some airlines may not allow you to fly in a full cast and it needs to be split open. You should contact your airline for more advice.
- Forearm Splint Care
Removable splints are used for soft tissue injury to your wrist. It helps to reduce pain, swelling and support your wrist following injury.
You should use your splint continuously initially, then during activities only and can be weaned out as your pain and comfort allows. You can remove the splint for exercises and shower / washing.
You should not drive with the splint on and should take advice from your insurance provider if needed.
Your splint may be washed by hand in warm soapy water. Remove the metal post first. Do not put in the washing machine as this may cause it to change shape. Do not put in the tumble drier and ensure your splint is completely dry before applying.
- Poly Sling and Collar and Cuff Care
Slings are commonly provided for injuries around the shoulder joint. There are several types of sling and the treating doctor will provide the appropriate sling that is needed for your injury.
The common one used in the Emergency Department is a sling made of cloth, this is usually a temporary sling as it can be quite uncomfortable around the neck.
The next type of sling is called collar and cuff. It goes around your neck and to your wrist without any support to your elbow. If allowed, you can take your forearm out of the sling to exercise your elbow and wrist and for hygiene needs.
The third type of sling that is used is called a poly sling. This supports your elbow and is more comfortable. It may come with a body strap, which you may need depending on your injury. It is important to attend to your skin creases for hygiene purposes. You can take your forearm out of the sling to look after your elbow crease and lean forwards with the arm hanging to attend to your armpit. You will be shown how to put it on and remove the sling in the Fracture Clinic for hygiene needs.
- Mallet Finger Splint Care
What is a mallet finger?
Mallet finger is a deformity to the end of your finger where you cannot straighten it. It is usually caused by a stubbing injury to the tip of your finger. There can be damage to the soft tissue (tendon) or bone.
How is it treated?
You will be treated in a splint if there is a pure soft tissue injury or only a small piece of bone is pulled away. You may need different treatment if there is damage to the joint.
How does the splint work?
The splint helps to maintain the fingertip in a straight position whilst the soft tissue heals. You will be able to move the finger joints below the injury to prevent it from stiffening up.
How do I manage the splint?
You should wear the splint continuously for six weeks to allow the tendon to heal. After this you can remove it during the day to move the joint an should wear the splint for night time for another 4 - 6 weeks.
You can remove the splint to clean the finger at least once a day. When you do remove it, you have to support the fingertip on a flat surface or with the other hand to make sure you maintain it in a straight position. If you let your fingertip bend it can take a longer time to heal or you may be left with the bent fingertip, which can affect your function.
There may be redness, swelling and slight pain over the joint for a few months afterwards. This will settle.
You may still notice a slight bend to the tip of your finger after this treatment, which is quite normal but if it affects your function you should contact your doctor for a referral to orthopaedic surgeon.
- Buckle Fracture Management
What is a buckle fracture?
This is the most common type of fracture in childhood. The child's bone is soft as well as flexible and has a thick sleeve of tissue (periosteum) surrounding the bone. This sleeve is very strong and protects the bone from breaking through completely, unless it is a high-energy injury. So there is only a crack or kink on one side.
How is this injury treated?
This type of injury heals well and quickly in about three weeks. All it needs is a simple splint for pain relief and comfort. The child may need regular simple pain killers (paracetamol or Ibuprofen) in the initial few days for pain relief even with the splint. The splint can be removed for showering / bathing without any risk to fracture.
If there is no pain after three weeks and the child is using the arm freely then there is no need to continue with the splint.
If there is little pain after the first three weeks the splint can be used intermittently as needed for another one or two weeks. It is best to start moving the wrist as comfort allows. You can consider giving simple pain killers if needed. However, if after three weeks the wrist still seems very sore, swollen, or the child is not willing to use it, contact the Fracture Cclinic to arrange a follow-up.
If the child removes the splint before the three weeks has passed, appears to be comfortable and can use the arm freely, then there is no reason to force them to wear the splint for the full three weeks.
Is there anything my child should avoid?
It is best to avoid sports and rough and tumble play when wearing the splint and for a week or two after its removal.
- 5th Metacarpal Fracture Care and Neighbour Strapping
What is my injury?
You have a break near the knuckle of your little finger
How is it treated?
Strapping your little finger to the ring finger for a week or two usually treats it. It is important to move your fingers as soon as your pain allows.
What should I do?
You can remove the strapping after a week or two and start using your hand as normal. This will not cause any further damage. You will be able to return to normal activities when you are able to make a full fist and fully straighten you fingers without any pain. It can be sore to lift any heavy weights for about 6 to 8 weeks.
How long does it take to get better?
Your handgrip strength will return to normal once the discomfort settles. It can take up to six weeks or a little longer before your feel normal. You may notice a lump around the fracture and your knuckle may not be as prominent as your other hand.