Table II.

Psychological impact – illustrative quotes.

Code	Illustrative quotes
Loss of confidence	“I mean we’re all super-cautious. I think psychologically, it’s worse than the physical side of it. If it aches, she takes some paracetamol and it’s fine. But psychologically, with this weather [getting worse] she’s very scared of slipping. She’s very cautious when out in public places in case anybody bangs into it. She slipped on the stairs and she dare not move, even look at her arm in case it had broken again.” (Interview #8, non-surgical casting) “I think sometimes he worries when he falls over. He thinks it might break again, but I’ve reassured him that I don’t think it’s any more vulnerable to breaking than a normal arm now.” (Interview #14, non-surgical casting) “I think with him it’s maybe slightly psychological. Sometimes, when he’s playing sport or doing anything he might not give 100%, it’s almost like 90%, because maybe he’s worried about hurting himself again, but physically he can do everything.” (Interview #16, non-surgical casting) “He was a bit apprehensive about doing things like playing football and we didn’t do anything too physical like that. He didn’t do PE (Physical Education) for a couple of weeks, and then he was a bit apprehensive. He fell over once and he was really upset thinking he’d broken it again, but I [said] “No, you’ve just fallen over. Every time you fall over, you’re not going to break it” and it was just about reassuring him. I think it traumatized him a bit that it got broken in the first place, but that’s subsided.” (Interview #15, surgical reduction)
Appearance	“I think she looked quite unhappy [when the cast came off] and said “look at my arm mummy”, but I just said to her “oh, it’s fine”. Then she was quite nervous about moving it, because she didn’t really have a full range of movement straight away. She can do everything with it now and it’s absolutely fine, but it did take a little while.” (Interview #19, non-surgical casting) “He needed to have an operation and I warned him there would be a scar, I warned him there would be a wire sticking out of his arm and it would have to come out. I think he was quite worried about the wire coming out which was out in seconds, but I think he was quite shocked having seen the scar. He never complained when the cast was on, but I think it was almost out of sight, out of mind. When he saw the scar, he almost, he said it was really, really sore but I think it was just seeing it.” (Interview #13, surgical reduction) “It was still quite misshapen, which they told us about, but I don’t think [my child] was quite ready for what that would look like. A few people at school [said] “your arm still looks broken” because it was still quite displaced.” (Interview #12, non-surgical casting) “It’s red and a little bit raised and she doesn’t particularly like it, you can see it and she’s a little bit paranoid about it.” (Interview #2, surgical reduction)
Missing out	“I think the only thing that really frustrated him was the fact that, in and out of school, he couldn’t play with his friends, because we didn’t want him to make it worse. I don’t think he could do sports for 12 weeks and I think that got to him the most, other than that he managed brilliantly.” (Interview #16, non-surgical casting) “I think he just got a bit tired of missing out. It was the snowball effect because it was the summer, he missed sports day and he missed some of his football games and cross-country. He missed out on a few bits and pieces coming towards the end of the school year and stuff.” (Interview #17, surgical reduction)