Wedging A Cast On A Broken Leg

I had some other posts sitting in queue, but thought I might write about our cast wedging experience instead. Oh the joy.

Franny was about 6-weeks (give a few days) post from breaking his leg. At week 5 he had the external fixator removed and a cast put on. 10-days later he was to come in for a recheck. He used his crutches to walk up to the clinic for the first time. I brought the wheelchair, for back-up, though. X-rays were first, and then the lengthy stay in the exam room. The nurse left the x-rays up for us to look at.

We stared at them for a bit (there were 2), and waited. Someone was getting a procedure across the hall and we’d glance over every now and then. I decided to snap a picture to send to Frank, who was at home with Lootie and the home-health nurse. I felt a glare from one of the attendees across the way, but it is MY kid’s leg, so what do they care? The real-life x-ray  is better, but you can see the 2 breaks (tibia and fibula) here, as well as the 4 holes from the fixator.

The Nurse Practitioner (or maybe it is RN) came in first and looked at the x-rays. She said you could see some good healing going on. She said his Orthopedic Surgeon would be in too look as well and we could ask questions (Franny always has a bunch) then.

He came in, with a “shadow” (training student), looked at the x-rays and started talking about a wedge; said everything looked good. Fibula looked pretty misaligned to me, but the side x-ray showed better alignment (assured the doctor). And they aren’t as picky about the fibula. It is the tibia that they are really concerned about (said doctor), and that one looked like it had shifty slightly. He said some doctors might leave it, but he’d like to have it pushed back. I could hear Franny’s small voice asking if he could weight-bear yet. Then I heard the doctor talk to the nurse. Then I heard Franny ask a bit louder. Doctor said, “Not yet buddy.” And we were rushed across the hall to trade rooms with the prior person in the procedure room.

We were given heavy vests to cover our body (Franny’s flimsily covered his scrotum and if I have grandkids with tenticles, we’ll know why). Franny asked about what they were doing, and they were so busy doing what they were doing, they didn’t answer. I asked them as well, and they said they were going to cut the cast and put a wedge in to place the bone a bit better. They twisted his leg this way and that to get visuals on the live xray; Franny was uncomfortable. “Is it going to hurt?” He asked a few times before getting an answer. They told him it might sting a little. He became more nervous. They used the saw to cut the cast (which he was assured wouldn’t hurt) and at the end he sucked a hard breath and started crying. “It stings really bad!!” They said it shouldn’t of, which he assured them that by golly it did, and then agreed that maybe it might have, since his bone was still broken there. The vibrations might have been uncomforable. I awaited gushing blood to spurt out, but it didn’t happen.

Note to nurse: obviously if he’s SAYING it hurts and he’s crying — it HURTS.

They cut a semi-circle in the back of his cast and shoved a plastic wedge in there to push the bone to a better position. Took a picture, showed the doctor, and were told to place a bigger wedge. The did, and then told Franny, who was crying, “All done buddy!!!” and that he did better than most adults. I asked if it would be sore later. They said maybe, and Tylenol would help.

We left. Needless to say, Franny did NOT crutch it out, but opted for the wheelchair.

Within a half-hour he was sobbing like he’s never sobbed before during all of this. He said it stung and his heel hurt. This is a kid that’s taken NO pain meds so far. Not after surgery the first time, not during stitches removal (which was done by the same nurse who helped with the wedge, and she’s no tender Wendy), not after his rods were taken out. And now he was sobbing as if he had his leg broken all over again. Which, I guess, he sort of did. Less the adrenaline and shock that comes with the trauma experience. He was relaxed and unready to have his healing bone pushed around as it was.

I called the clinic. I had no idea if this sort of pain was normal or abnormal. He’s got a high tolerance for pain, so it seemed very abnormal to me. I would think it to be normal, considering all that went down, but they’d said NOTHING about it being this painful. I conveyed my… exasperation to the nurse. We ended up giving him Oxycontin for about 48 hours, coupled with Tylenol (had the Oxycontin leftover from the hospital discharge – never touched it). It helped tremendously.

Today, four days later, he is doing much better. Thankfully. Though I still feel we went into the situation quite uninformed (and still feel rather uniformed about the progress of everything). I don’t know what the experience is for others who have had a wedge, but I’d say to make sure you have some good painkillers on hand, just in case your experience pain that warrants the use of them.

12 thoughts on “Wedging A Cast On A Broken Leg

    1. Thanks Judy.

      I would think that for a procedure that has the potential to cause that much pain some more information, prep or pre-med would be involved. I posted this in hopes that if someone were getting their cast wedged, they might ask more questions to be prepped ahead of time.

  1. Wish i found this post 5 hours ago. My poor 5 year old just went through the same experience, however I thought it was more out of fright. I get that the wedge to realign her tibia moved the whole broken part again and thats why shes trying to sleep it off. Guess we.are back to medicating on schedule and keeping it cool.

  2. My 9 yr old just had his tibia wedges. It was excruciating. Feel like we are starting all over again. Happy to hear that 4 days later your child had less pain again. It is so difficult to watch your child go through this, but so comforting to read stories from others who have experienced this before and are on the orher side now and all healed. How long were uour children casted for?

    1. Hi Nicole,

      He had (I think) 3 different casts. I’m sorry I don’t remember how long, though. He broke his leg in April and was back to wrestling by November of that year. He had a cast most of summer. It was so strange to see him without it when it came off! I hope yours heals well. It helped me a lot to read stories of kids that recovered, too. It felt like it dragged on forever.

  3. My 13 year old grandson a week ago fractured his tibia and fibula ( it was a compound fracture). Just 4 days after the break they put wedges in his cast. It was very painful for him and his mom and I left very upset. I am angry of the idea that for some reason doctors continue to underestimate and under medicate children for pain. This practice has gone on for years. Grands Mary

  4. Although I am glad I did so I can better prepare myself and my daughter (13 almost 14), I kind of wish I hadn’t know of the pain she might possibly endure tomorrow when she had this same procedure done. She broke tibia and fibia (open fracture) about 3 weeks ago, has a full leg cast for immobilization since they didn’t use pins, rods, or plates. So, she ONLY has the cast keeping her leg in tact for healing. She, too, has had NO pain meds other than Tylenol since surgery. Sounds like it is like starting over from the beginning. Good to know that after 4 days your baby was feeling better!!

  5. Adding additional comment… she wanted us to move her toes that night and cried off and on about pain. After 12 hrs medicated, we did ER trip were they re-xrayed, said it was “perfect”. Went BACK in next day, where they cut off the cast and realized it was cutting off circulation to her foot. She was black, purple and blue. They had to reset and recast AGAIN. Trust your instincts!
    Wedges move cast… there can be side effects!

  6. Was the wedging effective?? My son had this done 48 hours ago still in pain and terrified they might have to do it again or that he still might need surgery anyway! Ugh.

  7. Hi Amy,

    YES it was effective in his case and they did NOT need to do it again. I’m so sorry to hear that you are going through the same thing. Is he better now?

  8. Thank you. He had come through the pain and he is off the pills. Took about 72 hours. You moms are probably the only ones that would understand this but I’m so anxious … we had two weeks where I thought it was healing and now we are back to square one and we are trapped in the house because of the virus and all I can think about is going back to the hospital for the X-ray (scary) and what may be happening in the cast – super scary. Thanks for this post!

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