Limb fracture: recovery after cast removal (children)

Upper limb (arm) injury

Your child’s fracture has now healed and we have removed their cast.

If you follow the guidance in this leaflet, your child is likely to heal well, without needing physiotherapy.

What to expect

• It is normal for the injured limb to feel strange for a while and the joints to feel stiff. This is partly because the weight and support of the cast is gone.
• Your child may not regain full movement straight away. This will improve over the next 2 to 4 weeks.

Helping with recovery

• As soon as we remove the cast, we advise that your child use the arm that was injured for daily activities (washing, dressing and eating).
• By using the arm, they will put it through its normal range of movement and the stiffness will improve.

• Swimming is an excellent way to gain all-round recovery. We suggest your child tries this, even if they only swim for the first 8 weeks after we remove the cast.

• Vitamin D helps bones to heal, so we suggest you read this NHS information on vitamin D supplements.

Sports

• We strongly advise that your child does not take part in contact sports (such as rugby) for as long as the fracture/orthopaedic clinic advises. This is typically 6 weeks, but may be longer.
• During this time, your child can go swimming and can take part in non-contact sports (such as running).

Arm exercises after cast removal

Do each exercise 10 times (= 1 set). Repeat the set 3 times. 

If your child struggles with these exercises, they can try the following instead:

• throwing and catching a ball
• the rock/paper/scissors hand game
• the head/shoulders/knees and toes game
• hand clapping
• colouring
• using Play-Doh
• baking (mixing and measuring).

Arm injury recovery goals

4 weeks after we remove the cast, most children can do the following:

Shoulder injury

• shrug their shoulders
• move the shoulder in a circular movement
• lift their arm above their head
• fold their arm behind their back.

Elbow injury

• straighten the arm
• bend the arm to touch their shoulder
• with the elbow bent, hold their hand with the palm facing down
• with the elbow bent, hold their hand with the palm facing up.

Wrist or forearm injury

• bend their wrist up and down
• move all their fingers.

Finger injury

• fully bend and straighten the finger.

Lower limb (leg) injury

Your medical team will have told you when your child can return to full weight-bearing. (This means taking all their body weight on the injured leg).

What to expect

• For a few weeks after we remove the cast, it is usual for a child to walk with a limp or for the foot on the injured side to be turned outwards.
• It may be some weeks before your child can take all their weight on the affected limb. It is important that they keep practising.

Helping with recovery

• We advise that your child gradually practises walking at home, without using their crutches or Zimmer frame.
• Walking will put their leg through its normal range of movement and the stiffness will improve.
• When they feel comfortable and confident, they can do more walking outdoors.

Sports

• We suggest your child does not take part in contact sports (such as rugby) for as long as the fracture/orthopaedic clinic advises. This is typically 8 weeks, but may be longer.

Leg exercises after cast removal

Do each exercise 10 times (= 1 set). Repeat the set 2 times. 

If your child struggles with these exercises, they can try the following instead:

• lying on their back and cycling their feet in the air
• use their foot to make a 'high 5' to your hand
• throwing and catching a ball on 2 legs or 1 leg
• the head/shoulders/knees/toes game
• walking, heel to toe, along a line taped on the floor
• swimming.

Lower limb (leg) recovery goals

6 weeks after we remove the cast, most children can do the following:

Upper leg fracture

• stand on the leg
• walk without help
• move the whole of the injured leg forward, backwards and sideways (while standing on the other leg).

Lower leg fracture

• stand on the leg
• walk without help
• bend and straighten their knee
• move the ankle comfortably.

Foot injury

• stand on the foot
• walk without help
• bend and extend their ankle
• move all their toes.