Last Updated on Thursday, 24 October 2013 11:40
By Dr. Rob LaPrade
http://drrobertlaprademd.com
Question: My 12 year old son had pain and swelling after falling onto his forearm last week, and was put in a cast after x-rays showed a stable radius fracture. Is there any way that he can get back to playing Peewee hockey this year?
Answer: Wrist fractures are the most common fractures in Peewee and Bantam ice hockey players. In this age group, wrist fractures of the radius, the larger of the two forearm bones, sometimes go through a weaker area of the bone, called the growth plate, which consists of cartilage.
Because the forearm bones in this age group can still be relatively soft compared to adults they can also “buckle” on impact with no major displacement of the bones. Fractures that cause obvious deformity (not just swelling) are unstable and need immediate attention to reduce the displaced pieces, sometimes requiring surgery.
Stable fractures just need to be immobilized with a cast to control pain and to prevent further displacement of the bone. At the first cast change, after the swelling from the fracture has resolved, we often can fit a cast around a player’s hockey stick to allow them to resume playing hockey. The total time that these stable fractures usually need to be casted and protected is between 4-6 weeks.
Some wrist fractures are unstable and initially very angulated, involving both the radius and ulna bones. These types of wrist fractures need to be set back into place. We will often have them heal for 2-3 weeks to allow the fracture ends to become sticky prior to allowing a patient to be casted and then have the cast molded so that they can play hockey. It is very important in these circumstances that the X-rays demonstrate some early healing so that we know that it is safe for the player to resume on-ice activities.
The same rules usually hold for the resumption of stick handling and other shooting drills. It is best to make sure that the initial swelling is resolved from the fracture and that any fracture which had to be rebroken into place from an angulated position has evidence of healing prior to putting significant stress on it so that the arm does not become permanently angulated.
When the time comes to be fitted for a cast for ice hockey, it is important to work with one’s physician or cast technician to ensure that the cast both protects the fracture and allows one to play ice hockey. We ask our athletes to bring their stick and their hockey glove in for cast changes to make sure that the cast is properly molded around the stick and that the cast will fit into their glove.
So, to answer your question, yes, one can get back to playing ice hockey if one has a stable or healing wrist fracture and the swelling has gone down. A well-fitted protective cast can both protect the fracture and allow one to safely hold a stick while resuming on-ice activities.
Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado. He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. Formerly, he was the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the U of M. If you have a question for the Hockey Doc, e-mail it toeditor@letsplayhockey.com.
