Parents of children who fall and sprain in the emergency room often can not understand or accept the doctor’s instructions to require a cast to be fixed. So why do doctors put children in casts and what are the benefits of casts: A. Ankle sprains Q: Why should doctors put children in casts when they just sprained their feet? A: The difference between children and adults is that the strength of the ligaments is greater than that of the epiphyseal plate. When the ankle is sprained, the calcified layer of the epiphyseal plate separates under the pull of the ligaments, causing type 1 or type 2 epiphyseal injury. The fixation of the plaster can provide good healing conditions for healing. A 13-year-old male with a history of fracture of the right outer ankle for about 1 year came to the clinic with a sprain, pressure pain in the right outer ankle and no obvious swelling. 11-year-old male, sprain came to the clinic with swelling and pressure pain in the outer ankle; swollen shadow of the outer ankle was seen on X-ray, no obvious fracture was seen; MRI showed type 2 epiphyseal injury of the outer ankle. Q: Why did the doctor put the child in a cast when he just fell on his back? A: The difference between children and adults is that the strength of the ligaments is greater than that of the epiphyseal plate, and a green branch fracture without bending is not easily detected; the epiphyseal plate and surrounding ligaments are often damaged when the wrist is subjected to force. The fixation of plaster can provide good healing conditions for healing, and at the same time can relieve pain to avoid re-injury. 9-year-old male, no obvious swelling of the right wrist after an accidental fall, with light pressure pain and obvious external rotation; no obvious fracture seen on X-ray. C. ulnar hawk’s-eye Q: The child often fell and did not see a doctor, and there was no fracture on the film why should he be put in a cast this time? A: It is not that there is no fracture on the film, it is that there is no fracture as you think, the buckling of the bone cortex and the irregularity of the pattern can be called fracture. Then look at the child under the elbow pressure pain is obvious, flexing the elbow less than 90 degrees that there is clear resistance pain. 3 years and 8 months old, female, fell accidentally and injured the posterior part of the elbow with pressure pain, no obvious swelling; X-ray saw longitudinal fracture. Radius “small head” Q: Doctor, you told me to put it in a cast, so show me where is the fracture? A: The child’s radial tuberosity has not yet ossified, so the X-ray cannot show it, and the fracture line also cannot be shown and not all fractures have fracture lines. The child has a clear history of fall. Although there is no significant restriction of elbow flexion, there is significant pain after the forearm is rotated when the child flexes the elbow about 30 degrees. 3 years and 1 month old female, no obvious swelling from the accidental fall; although there is no obvious limitation of elbow flexion, there is obvious pain after rotation when flexing the elbow about 30 degrees. V. Supracondylar humerus Q: Our oldest doctor said it was fine, why did you say it was fractured? A: The doctor you saw earlier must not be a pediatric orthopedic surgeon. Children with cycloid fractures do not have obvious displacement or obvious fracture lines like adults do. For children’s fractures that are not displaced nor bent, they can only be judged indirectly on X-rays by soft tissue bleeding and swelling shadow. The child will often hold the affected hand after Kin and refuse to touch it, and the pain and pressure on the elbow will be more pronounced when the elbow is flexed near 90 degrees. 8 years old, 6 months, male, fell from the bar on the elbow mild swelling and pressure pain; X-ray shows: no significant abnormalities in the frontal view, lateral view visible sailboat signs. The child’s mother: doctor you say strange good, speak also understand, but I just do not want to give the child a plaster, we paste plaster how. Doctor: this mild injury without a cast home bed rest (ankle sprain) do not go to the ground, about 3 weeks to recover. (Upper extremity injury) triangle towel suspension, pay attention to less activity, about 4 weeks to recover. In other words, braking is necessary. Aunt child: if so why do you let us play a cast doctor: this injury will not be painful for about 3 days, once the child is not painful will be full of spills, easy to cause re-injury, repeatedly not easy to repair. His aunt: the child’s joints are fixed for so long will not make the stiffness. Doctor: About 3 weeks of immobilization, there is no effect on joint movement. The child’s grandmother: the child between more than days, how to bathe Doctor: polymer plaster is not afraid of water, in order to avoid entering the water after the child uncomfortable. You can wrap it with plastic wrap and don’t let him get into the water. The child’s grandmother: you tie your hands, my child how to eat? Doctor: The wrist injury is fixed only to the metacarpophalangeal joint, he can eat with a spoon. The child’s aunt: how can the child go to school, between the study can not be pulled. Doctor: the upper limb of the fixed plus hanging a triangle towel like to go to school, pay attention not to fall again can; lower limb of the fixed you can send him to school, go to the toilet to support the crutches can, pay attention not to fall. Grandfather: doctor we use to give the child some stewed ribs, steamed a crab tonic? Doctor: can eat, good things do not hurt can also be given to the child to eat the child’s father: ……. The doctor: the old man do not follow the rubbish, go, a family to discuss the child his 7 aunt 8 aunt 3 2 grandmother: doctor we still play a plaster it doctor: good, the plaster played, tomorrow outpatient review. The actual fact is that you can find a lot of people who are not able to get a lot of money for their own personal use. The forearm is mostly rotated anteriorly, resisting any slight external rotation of the flexed elbow angle, the child’s resistance to small angle flexion of the elbow is not obvious, but the child refuses any active activity. Radial neck (unossified head): pressure pain under the lateral elbow, most obvious in external rotation at about 30 degrees of elbow flexion, slight external rotation in elbow extension allowed Ulnar hawk’s eye: position latent table mostly positive on pressure, increased pain when elbow flexion is greater than 90 degrees Internal epicondylar and epicondylar fractures: soft tissue swelling shadow is obvious on one side, orthostatic supra-elbow swelling and subelbow swelling shadow are both present, pressure pain points are very clear Humeral ulnar disorder: complaints of elbow pain, but no clear pressure pain The point, extension of the elbow about negative 20 degrees flexion of the elbow less than 90 degrees, X-ray, CT confirmed no fracture. Give passive flexion of the elbow to 110 degrees mostly with a sense of reset or twisting, and the child can mostly regain voluntary range of motion after about 10 minutes. Supracondylar fracture: the sailboat sign is clear, the sailboat sign is not obvious, the pain increases when the elbow is flexed more than (90-100) degrees after excluding the hawk’s beak, and the pain increases when the elbow is straightened – (5-10) degrees or so, the above can be observed in triangular scarf suspension, and plaster is recommended.