# Remove arm cast before healed?



## drdoak (Feb 7, 2005)

Hi all - I wanted to throw something out there that an ortho surgeon recommended to me, and see if it was a common thing.

Back in April I had a high speed downhill OTB crash and broke my left ulna/radius about 1/3 of the way up my arm. The ulna was compound and came out of the skin about 4". Since it was on dirt, the break was filthy. The trauma surgeon ended up removing about 1/4" of the ulna because of the dirt compacted into the shaft. They put steel plates on both bones, but left a 1/4" gap in the ulna so I would retain the original length.









_ER x-ray_









_Arm repaired, notice the ulnar gap_​
Fast forward 4 months and my radius has healed, but the ulna has shown no real signs of growth. They call it an atrophic nonunion, and now want to do a bone graft surgery.

My original surgeon is out of my insurance network (still working on fighting that), so I just saw a local ortho surgeon yesterday. He is a team doc for the Ontario Reign hockey team, and has worked with the Red Sox and Houston Astros. He sounds comfortable with the surgery I need, but yesterday he suggested that they remove the cast and let me go about daily life without it. Keep in mind that my ulna is held together by a plate and screws only. Obviously, he said, I would need to be gentle with it, but he said it'd be good for my arm to get out of the cast and work on some movement and document what sort of pain I'm having. Plus, he said, there is support there from my radius.

I'm tempted, because this cast business is no fun. But it was *never* presented as an option with my original surgeon, and she is on vacation for 2 weeks so I can't run it by her. I guess since I'll be getting more surgery soon, and I definitely won't be lifting anything with it or riding any bikes, there isn't much risk in this? As it is, I'm in very little pain and have been off the pain meds for a couple months. Does this sound like anything people have come across before? Thanks for your input.


----------



## xcguy (Apr 18, 2004)

This is the internet after all so you're going to get opinions like mine but here goes: I can see what the new doc is saying, to get out of the cast until the new surgery because things would atrophy even further inside the old cast till the new cast is on then further atrophy :yikes: 

I was so freakin' psyched to get my cast off after six weeks I forgot which day I was supposed to go in. When I went in the wrong day they said "that was two days ago" :yikes: 
I basically begged them to get that sumb!tch off and they did.

I would imagine it would real tough for you to not try to regain some strength back before your next surgery (I couldn't work on strength for three months, just range of motion) so even if you only did ROM there's a chance you might overdo it (in light of the nonunion).

But, in theory, the new doc's opinion makes sense. If you promise yourself not to do anything stupid (and that would be "stupid" from a doctor/occupational therapist point of view) it sounds like a good idea. I wouldn't call the period after the first cast comes off "going on about your life". I couldn't even open a refrigerator door for three months with my right hand. I'm sure I didn't help you much but good luck on your ongoing ordeal. Heck, just being able to shower without a plastic bag over your cast would be liberating enough.

edit: of course my injury wasn't your injury. I didn't break those two bones, I totally fakked up my actual wrist including the distal radius and other assorted bones in there. I'd call your injury "breaking your lower arm" so recovery I'm sure is a totally different deal.


----------



## tomsmoto (Oct 6, 2007)

i had a similar break, but no bone protrusion from the skin. i RE broke it in the cast from slipping and falling. it took, literally, years to heal. even after the bone had fused i had bad ongoing pain. im sure your surgeon knows more than us, just saying be extra careful! re-breaking it hurts like all hell.


----------



## strangerthanmilhouse (Jan 18, 2007)

Im not a Dr. but ill chime in. I had a similar break skating a half pipe in 97. Radius, ulna, and all the little bones in the wrist. Multiple compound fracture at the wrist and halfway up the arm. When it broke it was like a razor slicing through the muscles and veins,about lost my arm in this one. Anyway i got 12 hrs of surgery, plates and screws and a nice cast. I hated having that cast on so bad. So after 6 weeks the Dr. said" Its healing really well". So a week later I decided to cut it off myself. Long story short-goofing off, i fell and re-cracked both breaks and had stress fractures at the ends of my plates. So all together i was in a cast for 10 months straight due to it not healing straight. Let it heal proper, dont be like me.


----------



## milehi (Nov 2, 1997)

I have nothing constructive to add, but I'd like to say GET THIS %^$&^$% CAST OFF MY ARM!!! 

Where's my home health nurse BTW?


----------



## Energetik (Feb 7, 2008)

I did something similar on my 10th birthday. Only mine was totally lame. I fell of a pile of tires onto my right arm. It broke clean (thank god!). It was both bones a few inches above my wrist. If I had been an adult I would've needed plates and screws or so said the doc I saw. I was in a cast for almost 6 months because it wasn't healing right. After that I was in a brace for a few weeks to be safe.

Anyway I remember, almost 20 years later, how unbelievably ITCHY the damn cast was. I couldn't shower without a bread bag. I couldn't scratch any of the itches, and it weighed a ton. (to a ten year old) It happened in september so I still had my tan. All that dead skin under the cast made it barely bearable. I was so happy to get the cast off.

Although I was tempted to get it taken off I had a friend who broke his wrist, and did take it off prematurely only to rebreak it far worse that if it had healed right. 

I didn't have it break the skin so I can't comment on that one. That blows. Good luck!


----------



## Kickbucket1 (Jun 1, 2007)

4 months post-op debriedment of compound fracture and open reduction internal fixation, radius healed with calus formation, 6-hole and 10-hole plates with cortical screws distal and proximal to fracture lines, recommendation from surgeon to remove cast to limit atrophy, start physical therapy and evaluate range of motion pain tolerance sounds like pretty good advice. But don't do it if you intend to go back to your primary orthopod, she'll be pissed you sought a second opinion. Why the second opinion? If you do take the cast off, be careful. Why didn't the surgeon put in cancellous bone chips or allograft bone putty in the gap before closing the wound? A 6mm gap would call for it. Plan on keeping the hardware in? You will probably need to keep the hardware in if graft is stuffed into the void, then come back when all is healed to take out the hardware. Food for thought. Ask about an external bone growth stimulator. Sure beats general anesthesia, risk of infection, pain meds and recovery from the second procedure. Maybe save that grief for when you remove the plates and screws. Oh and I slept at a Holiday Inn. Best of luck to you.


----------



## drdoak (Feb 7, 2005)

Definitely overdoing it without a cast is a concern of mine. The cast is a safety item; even though it's not helping me heal it's still protecting me from re-breaking it. I'm already probably doing too much with a cast, although I am in so little pain I'm not sure it matters. Maybe without a cast I would be forced to do less, which could help? Plus, as casts tend to be, it is horribly itchy and stinks.

As annoying as this is, I am extremely fortunate that it's just an arm and will (most likely) eventually heal without many ill effects.



Kickbucket1 said:


> 4 months post-op debriedment of compound fracture and open reduction internal fixation, radius healed with calus formation, 6-hole and 10-hole plates with cortical screws distal and proximal to fracture lines, recommendation from surgeon to remove cast to limit atrophy, start physical therapy and evaluate range of motion pain tolerance sounds like pretty good advice. But don't do it if you intend to go back to your primary orthopod, she'll be pissed you sought a second opinion. Why the second opinion? If you do take the cast off, be careful. Why didn't the surgeon put in cancellous bone chips or allograft bone putty in the gap before closing the wound? A 6mm gap would call for it. Plan on keeping the hardware in? You will probably need to keep the hardware in if graft is stuffed into the void, then come back when all is healed to take out the hardware. Food for thought. Ask about an external bone growth stimulator. Sure beats general anesthesia, risk of infection, pain meds and recovery from the second procedure. Maybe save that grief for when you remove the plates and screws. Oh and I slept at a Holiday Inn. Best of luck to you.


I really like the original surgeon but primary motives for seeing another doc are distance (2.5 hours away, where I crashed) and insurance issues. It is also a headache to deal with her staff, as she is a trauma surgeon and they work for her part time remotely while working other full time jobs. Plus she has been out of town since early July, can't see her again until mid-August, and I'm tired of sitting in a cast with a bone that's not growing when I could've had surgery a month ago. I'm seeing a third doc next week for yet another opinion. I don't think she'd be pissed -- I need to move forward with my life and if she (or her staff) can't make that happen, I need to find someone who will. Is it wise on my part to go with another surgeon? I'm still evaluating that.

Been using an Exogen bone stimulator for almost the entire 4 months with no results. Hardware will come out after things are all healed up, maybe 1-2 years down the road. Assuming I have insurance at that point in time.

I believe she did not do anything to the bone gap because of the risk of infection, we needed to make sure things were clean first. Or they didn't have what she needed available at the hospital, I think that's why my ulna plate ended up so close to my wrist. Thanks for your advice.


----------

