What Is The Prognosis For A Child With Persistent Pain, Tremor, And Swelling After A Salter-Harris Type III Fracture?

Patient: My son, 9 yrs old, (23 kg weight) Timeline: 11th November 2021: Hit right elbow against wooden chair leg - got a hairline 18th November: 14 days after fracture, since the pain was not reducing, the orthopedic applied synthetic plaster. It was kept on for 22 days. 18th December: Plaster removed, but his entire arm was swollen, with extreme pain in the wrist, fingers, elbow, and shoulder. He has the full range of movement but - after bending his elbow or writing/ brushing teeth his entire arm and hand are paining. The pain is constant, and aggravates at night. 30th December: NCS test conducted within 15 days of plaster removal – report normal. But to date pain has not reduced. 23rd January 2022: Complained of pain on keeping arm hanging, crepitus heard at forearm on pronation supination movements. Orthopedic examination by palpation of arm led to tremor starting in hand. From next day onwards, tremor occurred on keeping hand at rest even after waking up/ on turning hand like turning a key/ whenever pain increases after trying to write even 10 words/ brushing teeth/ eating. 9th February 2022: MRI done – report shows Salter Hariis Type III fracture in distal ulnar epiphysis , but no soft tissue or muscle damage. Nothing is mentioned in the MRI report about nerves. Tremor occurs when the hand is at rest, lying on a pillow or held without support, but not while doing any activity. Also his finger movements are slower than that of his left hand. Crepitus at the wrist has become loud now. He is also complaining of mild loss of sensation on the inner side of his arm and palm. Also after mild exertions like writing even 10 words hand starts to shake and the wrist swells up, pain is felt around wrist, at elbow, and on the forearm. Medicines taken: Gabapentin 100 mg for 1 month but no relief. Taking Omnacortil 10 mg followed by 5 mg (total 10 days) helped reduce swelling. Can you please shed some light on this condition? Also, another local neurologist for adults suggested Arkamin 0.1mg tablet and Dafza 12mg tablet for the tremor, but another local neurologist said no medicine is required. So we are confused about what to do, please guide. More details about the presenting complaint: Duration: Since 11th November Main Symptoms: Pain and intermittent tremor Tremor started from 27th January 2022 following orthopedic examination Previous history of the same issue: NA Current medications: Calcimax D syrup 12 ml daily Nurokind Syrup 5 ml daily Past medications of the same issue: Gabapentin 100 mg for 1 month but no relief. Taking Omnacortil 10 mg followed by 5 mg (total 10 days) helped reduce swelling. Lab tests performed: NCS MRI