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Pain in thumb after relocating the disclocated thumb.

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My name is John. My son Wes, 11y.o, 5'3" 120lb tournament level baseball player was involved in a collision Saturday at Home plate while catching. In this collision, though he held on to the ball for the out, Wes slightly dislocated his thumb backwards at the first joint (nearest the thumbnail) & fractured the thumb above the growth plate. The thumb was immediately popped back in place by a Trainer/Nurse on site & splinted - he proceeded to take his next at bat (was told to just stand there & hope for a walk) & to hit a walk-off for the win. That evening he got X-rays & was given an OvenMitt-like splint with Ace wrap from the ER. I have attached 2 views from the CD (contrast enhanced by me)

Sunday AM, a fellow baseball dad who is a Board Certified Orthopedic Surgeon saw him in his office & confirmed it was a buckle fracture that was NOT in the growth plate (was above) & then made Wes a heat-molded splint/brace (pictured) & told him though it would hurt like heck but that (speaking as a father himself with a same age child passionate about sports) Wes could play with the brace to the extent he could tolerate the pain - as it the brace would protect the thumb - and that he should wear it for 3 weeks continuously (except to bathe, etc), then for 3 more weeks in situations where he would risk subsequent collisions. (eg; catching) He did say that would not be his "doctor answer". (which in todays litigious world would be to use brace & don't do anything for 3 weeks) He also advised that a follow up Xray was not needed as it would absolutely heal as it was a buckle fracture & he was not a fan of kids getting needless additional radiation. That same day (Sunday) Wes did play & while painful to throw with any kind of grip using much thumb, - Wes did catch & threw players out & even hit a home run over the fence - so still functioned quite well. It's important to stress he wanted to participate - we told him we were happy with whatever he wanted to do & he was clear in that regard.

My wife is fearful of him hurting himself further, despite the Surgeon's blessing & help. While I have absolute faith & trust in the Surgeon, I am consulting to obtain a second opinion to assuage her fears, & affirm we are not substantially risking more serious injury (apart from baseball's inherent risks - which he is exposed to, injury or not)

QUESTIONS:

- Do you agree he can play to whatever extent he is able to tolerate with the brace on? He has 3-4 games per week for this weekend & next.

- Specifically, will throwing the baseball with the brace on pose any risks, including playing Catcher where you throw back lightly to the pitcher, say ±20x per inning, for 3-4 innings? and, possibly throw out a runner on a steal (hard throw) 1-2x per inning? He has adopted a fingers-only throwing style for throw-back to the pitcher which he says has no discomfort.

- When likely can he PITCH with the brace OFF? (your best guess) - as he is not permitted by rule to Pitch with any "gizmos" on his hand as it's seen as a distraction or aid. PS: they are limited to 2 innings by rule at this age.

Of course all thoughts & your expertise are appreciated.

THANK YOU!! John


Category: Orthopedic Surgeon

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Category: Spine Surgeon
Dr. Mukesh Tiwari is online now

Expert:  Dr. Mukesh Tiwari replied 4 Days.

Hello,
Thank you for your query at DoctorSpring.com
I have read your question with diligence .
I have gone through x ray.It looks that he had fracture above epiphysis of distal phalanx of thumb.The Astt or nurse had done right to reduce the fracture on sight.At present his injury is stable injury.You should not bother about this.
Our bones generally able to heal by forming sticky substance by about 3 weeks.At present his fracture is stable by splint but he should be cautious in using it heavily &excessively till 3weeks.He can pitch with brace off after 3 weeks.After 4-6 weeks he can use his thumb at any extent.
At present with brace he can play upto his pain level but as per my previous statement he should not use it heavily.
Hope this will help you.
Regards.


Dr. Mukesh Tiwari
Category: Spine Surgeon
Experience: 
Fellowship - Khandaka Hospital, Jaipur
Residency - MS, Rabindranath Tagore Medical College, Udaipur, 2000
Medical School, Internship - MBBS, SMS Medical College, Jaipur, 1995
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