Catching A Break

So I was in the ED the other night and a little 6 year old boy came in who had been playing at the park on a bench about 4 feet up. Unlike most of the children who come in here with a cough and a fever or a splitting headache...maybe even a split head...this one had fallen just so on a cement curb and halfway up his right forearm had snapped it backwards at 45 degrees. Now I had heard that should something such as this occur we were, as interns, expected to do the brunt of the treatment which means managing the sedation, reducing the fracture, and casting the poor soul...this is all under the supervision of someone who is skilled in all of this (my attending). Now I've sedated probably 10 or 12 children and I've placed casts and splints on a whole lot more, but I have never manually reduced a fracture. The majority of fractures that you see are hairline and only need support or they are fractured in such a way that you don't dare mess with them (ie. Cranial fractures or growth plates)...but this kid had landed on his arm just right and thanks to his thoughtfulness...or thoughtlessness that night I got to see and feel exactly what resetting a broken arm feels like. With trepidation I fixed my mask tight on my face, no smiles, no frowns, no wide eyes of terror would peak out from behind the frozen visage that had become my face. I wrapped my hands around his forearm just below the break and placed my thumbs over the two bones in the forearm above the break. As I had been instructed I
thrust my thumbs foreward pushing the broke arm suddenly into perfect alignment. Possibly it was the addrenaline giving me extra reserve...but maybe it was that easy...the was a crunch and snap like twisting a piece of cellary to breaking or snapping a dry twig and suddenly the arm was back in alignment and the repeat radiograph looked like perfection. It was done and so was I, in the mere seconds that seemed to elapse while treating the boy it seemed that an actual hour and a half had passed...as I walked out of the hospital to my car in the dark I allowed myself a great big smile...it had been a great night.

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