X-Ray shows no break, what is wrong??

NYmommy

Sun, Jan 08 2012, 12:14 am

Ds, just turned 2, tripped over an exercise mat on Friday morning. He was in a lot of pain so I went to the dr. We were sent to take x-rays but b'h there was no break. Its been almost 48 hours & he still can not walk, stand or put any kind of weight on that foot and still a little swollen. Is this normal? If its not a break can it still be something else that the x-rays wouldn't show?

hadasa

Sun, Jan 08 2012, 12:25 am

If there's a tear in the ligaments an x-ray will not show that, but an US will. There's also the possibility that they made a mistake when reading the x-ray. I think you should go back.

6coop

Sun, Jan 08 2012, 12:33 am

When my dd was almost 2, she had a hairline fracture of her finger that they were not able to detect on an x-ray until after it healed. It's also possible to tear tendons or ligaments, which cannot always be seen in an x-ray (they'd have to be specifically looking for it).

I have no idea what the case is with your child, but if I were you I would take my child to a pediatric orthopaedist as soon as possible. They'll probably order more x-rays, taken from many different angles (and possibly x-rays of the other leg for comparison). If it still shows nothing, then they will help you decide the next best step.

NYmommy

Sun, Jan 08 2012, 12:39 am

I dont think its a hairline fracture since he unfortunately fell 8 months ago & had a hairline fracture on his tibia. When that happened he was constantly in pain & was crying for days! With this one he is only a little cranky all day & only obviously in pain when he tries to stand up or put weight on that foot. I am thinking ligament but the doctor just said wait a few days.... I can not go to pediatric orthopedist without a referral from the general doctor, so far he hasn't given me a referral. Can a twist also be as painful or its definitely something more?

hadasa

Sun, Jan 08 2012, 1:18 am

I'm no expert, but it seems to me that if it's a simple sprain, even if it's extremely painful in the beginning, it should be showing signs of gradual improvement by the time two days have gone by.
Also, fractures are not always excruciatingly painful. I've had kids with fractures who were perfectly fine as long as they weren't moving the affected limb.
Can you call your doctor and tell him there's been no improvement?

emhabanim

Sun, Jan 08 2012, 8:29 am

As a physical therapist with 20 years expereince: Fractures can be m issed on an x ray - either by the machine itself or by the radiologist who read the film. Get a copy of the x ray and bring it to a different radiologist (preferably one with pediatric experience). If he concurs, you might want a second x ray. Even if that x ray is clear and your son is still in such pain, a CT scan might be in order or an MRI. There are fractures that a CT scan will pick up and an xray won't. As for a ligament, it is seen on an MRI as it is soft tissue. Ligament damage can cause intense swelling and a lot of instability in a joint so it can be very serious if it is a bad tear. Good luck and Refuah Shleima!

emhabanim

Sun, Jan 08 2012, 8:34 am

One additional thing... if your son has not yet been to an orthopedist and he is in such pain when he tries to stand and weight bear, he MUST go to one. This is not normal a few days after a fall. Tell your pediatrician that unless he gives you a referal , you are going to file a complaint with your insurance company. Document the day/time you spoke to your pediatrician and what your complaint/ his response was so that you can show you called numerous times with a child still in pain and were not given the referral.
If you do not want to do this, then simply take your son to the emergency room. Every ER has an orthopedist on call and all insurance companies cover ER visits. Yes, you will be in there for along time as your son will be low level triage... but he will be seen by an orthopedist. Go to a hospital with a pediatric ER.

OOTBubby

Sun, Jan 08 2012, 10:59 am

A similar thing happened to my GS. Eventually the pediatrician sent him to a pediatric orthopedist who said he had something dislocated in his pelvis. He snapped it back in place and all was fine. You need to see an orthopedist.

naomi2

Sun, Jan 08 2012, 10:30 pm

this happened to ds too. he fell and couldnt stand or walk and was very cranky about his foot. we brought him to the er and got x-rays that showed nothing. the next day he still couldnt bear weight on it so we went to a specialist and got a cast. after the cast was removed the dr rexrayed and was able to see that a hairline fracture had healed in his foot. when it happened innitially, it wAS such a asmall break and there was so much swelling that it was impossible to see. get a cast if he cant bear weight-you dont have to see a break for there to be one!

NYmommy

Sun, Jan 08 2012, 10:46 pm

Thanks for all replies. I still have his cast from his previous break. I tried putting it on but he still wont stand or walk with it. Im calling the doctor first thing in the morning I'h. Its 3 days & I don't see any turn for the better!
As a side note, the doctor did give me a prescription for a pediatric air cast (just so he can walk) but Fidelis does not cover it. Its hundred bucks so we couldn't try it.

NYmommy

Mon, Jan 09 2012, 6:36 pm

we went to a pediatric orthopedic dr today. He looked over the x-rays we took on Friday & noticed a fracture on or next to the ankle. (Not exactly sure what since my baby was screaming louder than him!) Also he tore growth center (like adults tear a ligament, kids tear growth center). He is in a cast now but so far he is still in a lot of pain & not walking, standing or putting any weight on that foot.
It was a good lesson (hopefully there wont be a next time) when something happens, x-rays should be reviewed by a pediatric orthopedic.

Thanks for all your help, was greatly appreciated .

emhabanim

Mon, Jan 09 2012, 10:52 pm

not to upset you, but to help you get the proper care for your son: did you ask the doctor the ramifications of the break into the growth plate? This can be more serious than the break itself. Many times kids break and it can hit the growth plate and there will be no damage. On other occasions, the growth plate - which is where all future growth will happen - has been injured. You need to know the status of the growth plate, as well as the precautions to take - if any - when the cast is removed. Good luck and refuah shelaima!