When The Cast Comes Off – It’s Still Crooked!

Parents often are surprised to see that their child’s arm is still crooked or slightly deformed after a cast comes off.

Don’t worry – this can be a normal part of the process!

This doesn’t happen all the time, but can be disturbing for parents if they aren’t’ prepared for this possibility.

Why is the arm still crooked?

As the bone heals, the body builds up calcium and new bone around the ends of the broken bone. This leaves a lump that goes all the way around the fracture. It’s the body’s way of adding strength and stability to the arm after the injury.

Swelling also goes down during healing of the arm fracture, so this makes the underlying bone more prominent, making the bump seem bigger than it really is.

How will it get better?

A child’s bone will straighten out after a fracture through the process of remodeling.

Remodeling involves the smoothing out of the crooked part of the bone. The younger the patient, the faster and straighter the bone will heal.

This is an x-ray of an arm fracture that is crooked in the first picture, less crooked in the second, and healed much straighter in the third x-ray.

x-ray of remodeling radius fracture children

remodeling of an arm fracture in a child

Will it hurt to use it while it looks that way?

The good news is that this is a normal process. Kids are pain-free during this time, and can usually use the arm normally while it’s straightening.

The bad news is that it may take a few years to fully straighten out. So it’s not a quick process.

Unfortunately, the only way to have a perfectly straight arm when the cast comes of is to straighten it in surgery beforehand.

What to ask your doctor

Ask if he thinks there will be a bump or deformity after the cast comes off. Will this straighten out over time?

Ask your doctor if it’s better to straighten the bone out in surgery rather than wait for the body’s natural healing process of remodeling. Ask about the risks of doing this.

This way you’ll know what to expect when the cast comes off and what the best options are for your child.

There are situations where more surgery is necessary if the arm is too crooked after healing. This is rare, but worth asking whether your doctor thinks this will be needed in the future.



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