Girls play almost as many strenuous games as boys, and so they, too, strain muscles and ligaments, and break a bone occasionally. And when a girl skis or plays hockey or basketball or tennis, she must do the same things the boys do if she wants to avoid serious injury.

People used to be happy when their doctors told them that a bone was not broken and that the injury was only a strain or a torn ligament or cartilage. Now we realize that some sprains and tears of ligaments or cartilages are just as serious, and sometimes more serious, than a broken bone. Injuries to the ligaments and cartilages of the knee are extremely common in girls as well as in boys, and they often cause more trouble and take longer to heal than a fractured bone. (The word fractured means broken). In some cases all a broken bone needs is a plaster cast for a few weeks, but some tears of ligaments or cartilages may need an operation to repair them.

Muscle sprains and sprained or torn ligaments or cartilages are very painful when they happen. The best first-aid treatment for such an injury is to keep the arm or the leg as still as possible and not to move it. Certainly no one should try to walk on an injured hip, knee, or ankle. If he does, he may make the injury a lot worse. A good deal of bleeding beneath the skin usually takes place when a muscle or ligament is torn. As a result, there will be a great deal of swelling in the area. Soon after the tear one may sometimes notice that the skin around the area is taking on a bluish color. This is caused by bleeding that has taken place under the skin.

The only sure way to know whether a bone is broken is to take an X ray, and this, as we know, must be done either in a doctor’s office or in a hospital. If a bone is found to be broken, the doctor will see whether the broken parts are separated and out of line. If the broken parts are out of place, the doctor “sets” or “reduces” the fracture. This means that he puts the broken parts back into their normal position. To set a fracture, the patient is usually given an anesthetic so he can go to sleep and feel no pain while the bones are being handled and put back in place. Occasionally, it is possible to set a fracture just by giving an injection of a local anesthetic, like Novocain, into the area of the break. In these cases, the patient feels no pain, either, but does not go to sleep.

After putting the broken bones back into their proper position, the doctor must make sure that they stay that way until they are completely healed. He does this usually by putting on a plaster cast. A cast is a bandage that is wet when first put on but later dries out and becomes hard and stiff. The stiffness and hardness of the cast protects the broken bones and keeps them from moving out of position. Once in a while, when the bones are broken in several places or are far out of position, the doctor will have to operate to put them together again. When he has done that, he sometimes keeps them in place by wrapping a wire around them or by putting in a metal plate from one part of the broken bone to the other. Naturally, these operations are done under anesthesia while the patient is asleep.

If the X rays show that a bone is broken but the broken paris are not out of place, then a cast is applied while the patient is awake. It is not painful to put on a cast. Also, it doesn’t hurt when a cast is removed, although the electric machine they use to cut a cast makes an awful racket.

A cast should be put on so that it prevents movement of the broken bones. To do this, the cast must cover the joints both above and below the break. As an example, if someone breaks a leg, the cast must cover the foot, ankle, and the knee. If someone breaks an arm, the cast may have to go from the hand all the way up to the shoulder.

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Casts stay on anywhere from three weeks to three or more months, depending upon which bones are broken and how badly they are broken. Naturally, if the broken bones are not out of place, a cast will not have to stay on nearly as long as when the bones are badly broken and are far out of their normal position.

Plaster casts are sometimes used for arms and legs when there is a severe muscle or ligament tear, even if no bone is broken. As mentioned before, some muscle and ligament injuries cause just as much trouble and take just as long to heal as some fractures. Casts are also applied in certain cases where the back has been badly injured. In these cases, the cast is applied to the entire body from the chest down to the hips.

There are certain rules everybody with a cast should follow:

1. Don’t allow a cast to get wet in a bath or shower. It won’t make much difference if it gets wet in the rain, as it will dry out quickly. Also, if we accidentally spill something on it, no great damage will be done.
2. No one should walk or put full weight on a cast unless the doctor has given permission to do so. Some casts can have special walking attachments put on, and then, it is O.K. to walk on them. People should know that walking or placing weight on a cast without the doctor’s permission may cause the cast to crack or break. Then, the fractured bone may get out of position. And even if that does not happen, it may become necessary to put on a new cast to replace the damaged one.
3. Don’t try to trim the edges of a cast by yourself. If necessary, the doctor will do it.
4. If there is a lot of itching beneath the cast, ask your doctor what to do about it. Don’t go poking things beneath your cast; you may scratch your skin or get a skin infection, and they might have to remove the cast before it is ready to come off.
5. It is perfectly O.K. to have your friends write or draw pictures on your cast. That won’t hurt it.

A sprained or torn muscle, ligament, or tendon may be painful for several days, or even weeks. Most broken bones, however, stop hurting within a couple of days after a cast has been put on. The reason a bad sprain or tear of a ligament or muscle hurts longer than a fracture is that there are many sensitive nerves in muscles and ligaments, but bones do not have so many nerves.

Did you know that people have more than two hundred bones in their bodies, and that the chances are very great that they will some day break one of them? But we shouldn’t worry too much when we do break a bone because when it heals, it is as strong as ever! And even if the arm or leg looks funny when the cast comes off, it will look normal again in a few weeks’ or months’ time. Children, especially, should not worry if an arm or leg looks a little crooked after recovering from a fracture. Children’s’ bones straighten out as the child grows older, even if they looked strange right after the cast came off.

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