Cast or No Cast: What Would You Do?

Posted by Dev K. Mishra, M.D., President, Sideline Sports Doc, LLC

I’ve got a little story to tell you about a young man and a cast.  For anyone not familiar with the term “cast” it’s a hard substance usually made of fiberglass worn during the healing of a broken bone.  If the cast is on, the bone is not healed. So here’s the story:

I took care of a prominent high school football player during the recent season.  He was a running back and prolific scorer, holding a scoring record at his high school previously held by someone who went on to a 12-year NFL career.  The kid can play.  In spite of his considerable talents his school team was struggling this season sitting just on the brink of making the playoffs.  With two weeks left in the regular season he is tackled hard to the turf and breaks his wrist.  He’s initially devastated because he’s a senior and will probably not play college football. We put him in a fiberglass cast, he sits out a week to make sure there is no swelling and he feels comfortable, and then he’s allowed to return to practice with appropriate padding on the cast.  He plays the critical final game, has three rushing touchdowns, and his school makes the playoffs.

Fast forward two weeks- now about four weeks after his injury.  He’s doing very well but the broken bone is not healed enough to remove the cast.  I decide that the safest thing to do is to allow him to continue playing with a padded cast, and his parents agree.  He is happy to keep playing but at the same time disappointed that the cast is still on because he can’t catch passes out of the backfield- one of his specialties.

I’ve known the young man and his family for 12 years, so I show up for the playoff game.  To my amazement, my patient jogs onto the field for warmup…and NO cast.  After confirming that I’m looking at the right player I watch the opening series with a pit in my stomach.

The story does not really have a happy ending.  He is tackled hard on his first rushing play; he reinjures the wrist and does not return to play.  The team loses badly and there are no more games for him.

He comes sheepishly to my office on Monday, x-rays show that the wrist is rebroken but still treatable in a cast.  I found out that his father took a hacksaw to the cast just before game time, and amazingly his trainer and coach allowed him to play.  He now takes the time to get properly healed for lacrosse.

So here’s the question:  as a parent, what would you have done?

I think we can all empathize with a parent who has spent countless hours over many years helping his son achieve a level of real excellence in a sport he loves.  We can empathize with the young man and his parents when his career is threatened with coming to a crashing halt at the very end.  But I have to tell you I’m a bit baffled by this one.  After all, we found a way for him to keep playing effectively.  Essentially, the cast was removed so that a few pass plays could be put back in the game plan.  In your mind does the possibility of some extra plays justify the risk?  It’s easy to sit back as an “impartial” observer and pass judgment, but try and put yourself in their place.  Might you have done the same thing?

In case you’re wondering about the rules of playing football in a cast, here’s what the National Federation of State High School Associations says:

1.5.3(c)

Hard substance in its final form such as leather, rubber, plastic, plaster or fiberglass when worn on the hand, wrist, forearm or elbow unless covered on all exterior surfaces with no less than 1/2 inch thick, high-density, closed-cell polyurethane, or an alternate material of the same minimum thickness and similar physical properties to protect an injury as directed in writing by a licensed medical physician (M.D./D.O.). Such written direction shall be provided to the umpire prior to the start of the game.”

The rule was working, but in this case real-life got in the way.

This entry was posted in Coaches, Football, Parents, Prevention, Sideline Sports Doc Miscellaneous, Treatment. Bookmark the permalink.

5 Responses to Cast or No Cast: What Would You Do?

  1. Scott says:

    I’m in the same boat with my 12 year old. He broke his thumb and has a fiberglass cast to his elbow with the thumb covered. He knows he can’t play offense, but wants to play defense. He would be a starter at defensive end or linebacker, he was the starting tight end and full back, but the PA who evaluated his injury wrote a note for his school PE that he can’t play any sports, is to keep his feet on the ground, no wheels and this is for 30 days.
    Is his age a major factor in his decision to shut him down? We have had two others play with casts on defense and the padding doesn’t hinder their performance or ability to tackle, the PA said his concern would be a fall impacting the forearm with the cast being a lever. My kid knows hos to fall. I’m still thinking about this. what do you guys think

  2. Dev Mishra says:

    Scott,
    I can’t comment on the specifics for your son, but there are some general things to consider. First, everyone is unique and it’s tough to compare from one person’s injury to another. There are certain types of fractures in the hand or wrist where we need to be very careful, so I can see where the thinking could be coming from. Second, there’s a bit of judgment that only the treating practitioner can give. In almost every case the treating practitioner wants your son’s best interest in mind, but if they are used to sports medicine they will usually be receptive to questions from parents. My suggestion would be to bring your comments up with the practitioner in a non-accusing way and see if there’s a compromise that leads to safe healing, but maybe some earlier return to play.

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  4. John says:

    I know this post is almost a year old but the timing of me finding it is perfect. My son hurt his wrist last week after taking a hit from a facemask. The Dr. x-rayed it the following day and the results were no breaks or fractures, however they put him in a splint. They told him to lay off for a week and then come back. He’s been in a splint all week and he’s dying to get back in time for this week’s divisional game. The swelling has come down so much that the splint was falling off. We’re just wondering what the chances are of the doctor allowing him to play since it was not cast. I thinking taking a hacksaw to the cast is a bit extreme. We would have been more than happy being able to play with the cast.

  5. John jones says:

    My son broke the growth plate in his left elbow which required surgery to insert a screw. The doctor did not put a cast on for fear of a loss of mobility. Instead the doc put on a fiberglass brace which covers the wound. My son is devastated that he might be out for the season. Since he has the fiberglass brace which covers his arm would he still be able to play if he uses an additional elbow pad. He plays running back and linebacker and he has displayed that he can still hit.

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