Hip Spica Patient Neglected, Left Sitting In Soiled Cast For Hours

Hello Les,

We're from Australia. My family was in a hit and run accident earlier this year and one of my daughters was messed up pretty badly:
ABC News: "Hit-and-run accused still has driver's license"

This is when I first learned about the hip spica cast ... I am very pleased to have found your blog online.

A couple of things I found:
My daughter was seven and toilet trained - she found it very distressing to use a nappy and preferred the pan; however, the Children's Ward didn't have buzzers to call nurses, so it was very hard to get help when needed.

She stayed in the hospital for about 10 weeks. She was excited about the cast coming off, but was emotionally drained afterward.

In Australia hip spica casts are rarely used, so the nursing staff has no experience with them.

My greatest fear was septic pressure sores. The learning to walk again was very hard on us all emotionally. A combination of all her injuries made progress slow.

I have been asked to write an impact statement regarding the consequences of the accident. I am trying to find some info regarding the mental and emotional impacts others have experienced as a result of the hip spica. Apparently, I have to determine what my daughter experienced due to each aspect.

This statement is complex with my four girls and my mum all injured in the crash. My father in law was killed.

Thank you for writing online. Information is power and you are empowering many parents.

Regards
V.

---

Dear V.,

Thank you for your email, and I am very sorry to hear that so many people in your family were hurt - and that your father in law was killed. My condolences.

Actually, the hip spica cast is not used much here (the U.S.) either. The nurses were basically clueless when it came to caring for my son in the New Jersey hospital he stayed at. (They fastened his diaper incorrectly over his spica cast.)

I will see what I can find to help you with your impact statement. Maybe readers of this site can help too.

Les

---

Hi Les,

I wish I had searched more about the spica cast, but at the time I was overwhelmed by everything. However, I think there is a lack of information about this on line. In fact your blog was the only really informative thing I found.

It is interesting that they consider removing and reapplying a caste if soiled over there. Here in Australia it was not an option considered.

I had one senior nurse assigned to my daughter and 4 other children on one shift. My daughter sat in "number 2" for hours and it seeped up and down the cast.

This nurse said sorry but she had been too busy and had asked once if the pan was needed at the beginning of the shift. Once in 6 hours!

I bet the nurse uses the toilet more than that! None of the other parents had even seen her during the shift before I started looking for her.

The worse part was I knew I could not care for her at home. When the cast was removed the physio removed the bottom half before I saw it and sent it to the medical photographers as there was to be an investigation into the mass soilage in the cast.

Apparently some is expected but not that much. From then I spent every waking minute traveling to appointments for the others or at the hospital trying to prevent it happening again. The removal was a relief.

Everyone is slowly recovering - it has been 6 months since the accident but we have a long way still to go.

Thank you for your response.

Regards
V.

Taking Off the Hip Spica Cast: What to Expect

Hi There,

The big day is coming: my son will soon have his hip spica cast removed. Can you tell me what you remember regarding the steps of removing the cast? Did it get buzzed off? Did it come off in sections? How did your son react before and after?

I want my son to be prepared, so please provide as much detail as possible.

Thanks again for all your help and support,
Michal

(To read more about Michal and her son, see the post at the following link and read the comments.)

---

Michal,

When our son Akira had his spica cast removed, they took a small electric saw - one that cuts fiberglass but not the skin - and cut the cast lengthwise on either side. They then opened it like a clam and took it right off.

Akira was scared to death and crying, so I did my best to comfort him by holding his hand. He was also beside himself with fear after the cast came off, because the heavy weight he had gotten used to was suddenly gone.

We were told not to bend his legs on the day of removal. We put a pillow on top of his legs and that was reassuring for him, even if it wasn't as heavy as the cast had been. We also wheeled him out in the same wheelchair we brought him in with - with his legs straight out in front of him.

Akira bent his legs during the night, but wasn't able to stand up for a few days after the cast came off. The leg with the healed femur was thinner than the other leg and strangely hairy.

Les

Hip Spica Questions: Sleeping, Bathing, Toilet

Dear Les

My son who is 6 yrs old will be having surgery next Friday and will have a Hip Spica Cast for four weeks. I thank you for your blog on Hip Spica cast and I was wondering if you have any other tricks to help him get through this or help his parents get through this!

I worry about how he will sleep. How did you give him a bath? Did you use a bed pan? etc…. I also see that you use the Cast Cooler and I was wondering if that really works?

Any insights or suggestions would be great!

Dave

---

Dear Dave,

One "trick" I would recommend is to help your child get mobile. An ingenious reader of my blog devised a "spica skateboard" that her son Lali lies on and uses to scoot around. I did not build such a thing for my child, but would have if I'd thought of it or seen this reader's blog.

Little Lali on his spica skateboard

To see a video of Lali riding his spica skateboard, click this link.

Other than what I've mentioned in my blog (buy a fabric tunnel he can play in, make sure toys and books are always within reach, take him out on a wheelchair every day, keep his room cool), there's not much more I can add.

Regarding bathing & sleeping, see this post.

We did not use a bed pan (our son wasn't toilet-trained), so he wore diapers.

Re the CastCooler, I did not use this device (didn't know of it at the time, but certainly would have tried it if I had), but it has been highly recommended. One big fan is a reader by the name of Mike. You can read his testimonial here.

Or go to the manufacturer's site and ask questions there: CastCooler.com

Please let us know how things go with your son, and send us updates!

Les

Itchy Hip Spica Cast Relief

A reader finds a way to relieve the unbearable itch his son suffers in his spica cast:

Hello,

Back in February of this year my son Jack was playing with his friends in the gym and took a bad step and suffered a spiral fracture to his left femur. Long story short, he was placed in a Spica cast and came home from the hospital a couple of days later. At the time he was 3 years old.

After a couple of days his leg started itching so bad that it would wake him up from a deep sleep and it would keep him up for hours. After 3 days of this, I was desperate to find some type of relief for him. I did a search on the Internet for "itchy Spica cast" and came across the CastCooler and purchased one right on the spot (at 4:00am). When we received it, I quickly placed it on Jack's cast and the relief was immediate.

We used the CastCooler anytime he requested it, which was around 2-3 times per day for about 1 minute each time. He even peed in his cast at one point in the middle of the night, and it extracted ALL the moisture after about 5 minutes.

After 6 weeks, the cast was removed and the nurse in the clinic mentioned how good it looked and that it had no odor (I still have the cast and it does not smell). It was a product that I was so impressed with, I just had to write Mr. Dunagan and tell him about our experiences and to thank him for bringing such a product to market. It was a life saver!

I hope this helps.

Mike

Diarrhea in the Hip Spica Cast

Hi there - I found your blog googling "spica cast." Our 2.5 yr old son fell and broke his femur. He was put into a spica cast. Here is my blog, so you can see how he is doing:
http://lalicast.blogspot.com/

My question is, this morning he had diarrhea and it went up the cast. I used up 2 boxes of baby wipes just wiping out what I could. I called the orthopedist and they say to bring him down so they can redo the cast, which means general anesthesia again.

It took him 2 weeks to recover from it last time; he was vomiting and refused to eat for 2 weeks. He is now at a point where he is as happy as he can get. I am so worried that putting him under will be another setback for him. What would you do? Did you experience this at all? What did you do to prevent the stool from going up into the cast?

Also, either he lost weight, or the cast became looser - so he can move a good inch in there. Is that a problem?

Any info will be helpful. Thanks so much and I am so sorry to bother you but we are stuck here.

Michal

----

Michal,

So sorry to hear your son had this accident in his cast. Just so you know where I'm coming from, I'm not an expert. I'm just a poor schmo like you whose son broke his leg and I had to take care of him for 7.5 wks.

I would do as your orthopedist advised. I know it's terrifying to see your boy put under again, but the surgeon knows what he's doing, not to mention the anesthesiologist. If you don't get a new cast put on there's a high chance of infection from the dirty cast.

Tell the doctor about the cast getting loose. If it's too loose this can be a problem.

One thing I would recommend is trying to figure out why your son got diarrhea. Is it something he ate? Did he get a virus?

I don't know your situation (Is your son in daycare? Are you caring for him at home?), but is there any way you can prevent this from happening again? I'd recommend keeping him away from sick kids (if possible), and closely watch what he eats.

I was a bit of a control freak when it came to what my son ate b/c I was terrified he would get diarrhea. We made sure to feed him high-fiber foods (whole grain bread and cereal [Cheerios], fruits like strawberries, mangos, kiwis, vegetables like carrots, etc.) I also kept him away from his brothers when they started showing any symptoms of illness. We were lucky - Akira never got sick.

To avoid his feces going up into the cast, I would have him sitting up as much as possible and fasten the diaper as described in this PDF (with a sanitary pad underneath the diaper):

http://www.vanderbiltchildrens.com/uploads/documents/ortho-hc0425.pdf

In our case, we had someone with Akira all the time while he was in his spica cast. (We had to hire a babysitter for this- at a cost we really couldn't afford - as I had two other sons to look after.) We made a point of changing his diaper as soon as possible after he defecated.

Hope this was helpful.

Pls keep in touch and let me know how things go.

-Les

NOTE: Read the comments to see updates regarding Michal and her son.

Seek a Second Opinion For the Hip Spica Cast

This reader sought a second opinion regarding his 2.5 yr-old son's fractured femur and was able to avoid having a pin inserted in the boy's leg and the limb put in traction:

Hi Les,

I hope all is well. I found your site when I was researching about kids with broken femurs.

On the 24th of June '09 my son, Nolan (33 months), fell off his bunk bed while playing with his brother and his cousin. I had left them alone for 2 minutes to fix a corner of the computer desk so they wouldn't bump their heads on it ... then I heard the most horrible sound I've ever heard and found him lying on top of the bottom rail.

As soon as I picked him up I saw a lump on his right thigh and felt the bone. He was brought to the E.R. for x-rays -- it was broken at the midshaft.

After he was put in a spica cast we followed up with a visit to an orthopedist, and the doctor told us he needed traction to realign his bone. The method is horrible: he would not be able to move while they use weights to stretch the bone, inserting a screw the size of a pencil above the knee.

My wife and I were horrified to think of the pain he would go through and that we wouldn't be able to hold him for 2 weeks! So we got a second opinion -- and thank GOD we did!

Somehow, through the power of prayer, the bone realigned to a better angle! We are so happy he doesn't need that surgery!

The point I'm trying to make is that maybe you should post this on your site so that parents get a second opinion.

I just wanted to let you know that you are a WONDERFUL father, and your boys are beautiful!

I know your site has helped a lot of parents dealing with the same horrible ordeal.

Can you please tell me how Akira is doing now and if he has any shortening or lengthening of his injured leg or any other complications?

Thank you, and GOD bless your family,
Andy

--

Andy,

Thank you for your email. I'm glad to hear Nolan didn't need to have pins inserted in his leg and have his limb put in traction.

At 2.5 yrs old I'm guessing Nolan will heal more quickly than Akira did, and that there will be fewer chances of complications. Please let us know how things turn out for him.

Akira is doing fine. He runs and walks around like any normal 4 yr old now and we've seen no abnormal lengthening of his injured leg (our orthopedist told us it's lengthening that may occur, as the healing on that leg might cause the limb to grow more than the other).

Les

Note: Read the comments to see updates regarding Nolan's condition.

If Your Child Pees in the Hip Spica Cast

Another email from a reader:

Hello. I was reading your blog about your son being in a hip spica cast. My daughter is 2 1/2 and broke her femur April 18th. They hope to be able to take the cast off on June 9th.

The other night she wet through her diaper and got the inside of the cast wet and now it smells bad. What did you do to get the urine smell out of Akira's cast? Any advice you can give me would be greatly appreciated!

Thank you and hope this email finds you and your family happy and healthy.

S.
________________________

Dear S.:

Thank you for your email. We are now all happy and healthy, thankfully. (And I keep my fingers crossed).

When Akira's diaper leaked into his cast we tried a number of things. First we removed all the moleskin edging, then wiped the cast with a warm, damp cloth. The smell remained, however, so we tried spraying it with Fabreze. This didn't help.

Desperate - our home now smelled like a public urinal - we called Akira's orthopedic surgeon and he recommended, jokingly, that we spray the cast with perfume. The truth is, he told us, there's nothing you can do. So we lit a scented candle and did our best to ignore the stench.


After three days, something miraculous happened: the smell almost totally disappeared. Akira still stank like pee, but you had to be quite close to him to notice it.

I think the cast finally dried out. (It was during the summer, so we had the air conditioner running and trained a fan on Akira while he slept, as it can get very hot and sweaty under the cast.)

-Les