Wednesday, December 10, 2008

Hip Spica Cast: What to Expect


On June 20th, 2008, my 3-year-old son Akira broke his left femur in a fall and had to wear a cast encasing his waist and both legs for seven and a half weeks.

Because he wasn't toilet trained and couldn't move -- he had to be carried or pushed around in a wheelchair -- our world was turned upside down.

If your child has suffered a similar injury and you're frantically searching the Web for information on fractured femurs suffered by 2 and 3 year olds, you might appreciate knowing that such accidents occur more frequently than you think in young children.

According to the American Journal of Public Health, “the incidence of femur fractures in children is believed to have 2 peaks, one at the age of 2 to 3 years and another during adolescence.” (“Femur Fractures in Infants and Young Children,” April 2004.)

In our case, Akira fell from a height of about three feet -- that's all it took. In another case I know about, a 2-and-a-half year old jumped from a top bunk bed and suffered a similar injury.

One incident I read in a blog involved a 2 year old running across a room, turning suddenly and thereby snapping his femur.

These things happen. It's natural as a parent to feel guilty: blaming yourself for not having been more careful, not watching your kids more closely, etc.

I blamed myself for not being in the room when the accident happened. But kids do what kids do, and there's only so much a parent can do to protect them, or prevent them from harming themselves.

The good news is, kids at this age heal quickly, and “most children with fractures of the femur have a satisfactory outcome,” orthopedic surgeon Steven Frick said in a presentation to the Orthopaedic Trauma Association. (“Fractures of the Femoral Shaft in the Pediatric Patient,” Aug. 2006.)

With Akira, he broke his leg on June 20 and “graduated” from physical therapy school on Oct. 1. (They gave him a mock diploma.)

It is now Oct. 5 and he can walk, run and jump. That Akira is not 100% recovered yet is obvious when he walks haltingly up and down stairs and in his inability to walk long distances. (In a recent trip to the Children's Museum of Manhatten, which involved a lot of walking, I had to carry him part of the way.) But the physical therapist said he'll eventually be able to do these activities.

“Have him practice climbing and descending steps every day. He'll get the hang of it,” she told me. “It'll take longer for him to build up stamina, but he'll gain this too, over time.”

So it took about three and half months for Akira to return almost to normal. And these were long, extremely stressful, three and a half months. Here's why:

- One person had to watch Akira and keep him company at all times (see "Child Care & the Hip Spica Cast"). I took on that duty, as it required heavy lifting -- Akira and his cast -- and we hired a babysitter to watch his triplet brothers. Needless to say, this help did not come cheap.

Akira reading a magazine on the mattress he occupied during the day.

- Akira had to be bathed and fed separately.

- We had to ensure his cast stayed clean and dry. (See "Keeping the Hip Spica Cast Clean.")

- Because of the extra care Akira needed, our days started earlier and ended later.

- On the advice of the hospital nurse, we had Akira sleep in the living room downstairs.

- Our car, a Honda Civic, which can normally carry all five of us, is not big enough to accommodate the special car seat for Akira's hip spica cast, so this severely restricted our travel options. (We had to make two trips wherever we went.)

- After Akira's cast was removed I had to put him through his physical therapy exercises every day.

At the time, it felt like this ordeal with Akira would never end. But when it finally did, it felt like a great weight had been lifted.

So if you, as a parent of triplets, experience a similar misfortune, don't despair. As the saying goes, "And this too shall pass."

Akira walking on the beach, 3 weeks after his cast was removed.

Further reading:

Child Care & the Hip Spica Cast
Keeping the Hip Spica Cast Clean
Hip Spica Cast Patient Information (Vanderbilt Children's Hospital)
Hip Spica Cast: A Guide for Patients (Univ. of Iowa Children's Hospital)

Sources:

“Femur Fractures in Infants and Young Children,” American Journal of Public Health, April 2004:
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1448296

“Fractures of the Femoral Shaft in the Pediatric Patient,” presentation for the Orthopaedic Trauma Association, August 2006:
http://www.ota.org/res_slide/P09_Pediatric_Femur.ppt

14 comments:

Anonymous said...

Hi Les!

I just want to know what type of exercises did the physical therapy apply with Akira? Because, my son's cast is already removed. Please advise.

Thank you!
Rb

Les Jacobs said...

Sorry for taking so long to get back to you. I have now set things up so that I'm automatically notified by email whenever a comment is posted.

The physical therapist put my son Akira through a whole range of exercises at the clinic - too many to list here. When I asked her to furnish me with handouts, she reduced them to about ten.

It is difficult to describe the exercises without pictures, but they were all designed to strengthen muscles through repetitive movement. Here are some examples:

1. Place a rolled-up towel under each knee (first one, then the other) and have him raise his foot until his leg is straight. 10 times per set.

2. Have your child sit on the couch and twist his foot to point to the right, then to the left. 10 times per set.

3. Have him walk up and down steps. Only a few at a time at first, then more as his legs get stronger.

Your child will probably use the rail or wall for support. Have him do a few steps with hands on head (or holding a book on his head) so as to re-learn to balance himself while climbing stairs.

There were many more, and I hesitate to recommend any as I'm not a physical therapist. My advice to you is to make an appointment with a PT and ask him/her for a list of exercises, as I did. Then watch the PT put your child through his paces to make sure you understand completely how he should do them. Then, return to the PT every few weeks so they can monitor how your child's progress. That's what we did (to avoid the crippling $50 per-visit copay) and it worked.

Tareq Ali said...

You blog is great and helps alot.
I have a question about your son status, after while does he return to 100% normal state? how long did it take to recover compeletely.

I'm really worry about duaghter, she is in cast now.

Last question: it is the 4th day now and my daugther still in pain, how long does it take to get used to that cast?

Les Jacobs said...

Tareq Ali,

If your daughter is still in pain, you should take her back to the doctor. Maybe the cast was put on incorrectly. This is very important. You don't want the leg healing wrongly, or your daughter suffering pain for no reason.

Les

sasha said...

Dear Les,

I just cant thank you enough for the information you provided me with, i ve been searching the web like crazy, and most of the stuff i read were irrelevant!

My son also fractured his femur, but due to a bone Cyst that apparently he was born with but we had no way of finding out except after a fall!
he had an operation were they fixed a plate and 8 screws...it has been exactly oe month since he had the operation and hopefully we will remove the cast withen the coming two weeks..However, I'm so worried about the coming phase which is him without the cast, I dont know what to expect, and since it has been 2 years since your son fractured his femure, maybe you can tell me when to expect that he can go back to the old him, he is 5 and half by the way..I hope your son is doing geart now..

Thanks again, and i really can't wait to hear from you

Sasha

Les Jacobs said...

Sasha,

My son has completely recovered; there is no difference in the length of his legs, and he has no trouble walking, running, or engaging in all other activities with children his age.

When the cast was first removed, however, it was a much different story. The healed leg was thinner than his other leg and the muscles had atrophied (the leg in the cast was also strangely hairy).

Akira was terrified when the cast was removed, as he was used to the heavy weight of the plaster. We put a pillow on his legs, and this calmed him. It acted as sort of a substitute for the cast.

Akira also couldn't bend his leg. In fact, he didn't bend it until the next day (he did it in his sleep).

Whatever you do, don't force him to bend it. The orthopedic surgeon told us that. Let him bend it when he is ready.

Akira laid on his stomach for a few days, just as he had when the cast was on. Then he eventually got up and started walking. Seeing his brothers running and playing around him was his motivation, no doubt.

Our orthopedic surgeon recommended we take Akira to a physical therapist (PT), and we did. We also put him through a little more than six weeks of daily leg-strengthening exercises. I did these at home, and took Akira to the PT periodically to make sure I was doing them correctly. (The surgeon wanted us to do the exercises with the PT at the clinic, but the copay was expensive, so I asked for a list of the exercises from the PT and put Akira through the paces myself).

Your son's situation sounds very different from Akira's, however. He is older and he has a cyst, correct? Thus he may take longer to heal (the older we are, the longer it takes) and he may need different exercises than Akira required.

Be sure and ask the orthopedic surgeon. Ask lots and lots of questions.

One piece of advice: be sure he's around playing children after the cast is off. What I mean is, if he doesn't have any siblings, take him to the park or have him visit friends or relatives his age. Seeing other kids hopping around will give him a reason to get up and get moving again.

Anonymous said...

Les,

Thank you for your blog and postings. You have provided me with a wealth of information and resources. Please keep up the good work. Your blog is the only resource I was able to find on the web to give me some perspective on my 3 yr old son's broken femur.

I am glad to hear Akira is a happy healthy boy.

Les Jacobs said...

I am so glad to hear this blog has been of use to you. Thank you so much for commenting

Anonymous said...

Hi Les,
So glad I found your blog. My 2-year old son fractured his femur a week and a half ago. With his cast, he is in a sitting position, both legs are bent at the knee. Anyway, he's had a really difficult time sleeping-he wakes up many times during the night and isn't getting good naps. Any advice?

Les Jacobs said...

You're going to have to be creative with a mattress and cushions. See this article:
http://hipspicacast.blogspot.com/2008/12/child-care-hip-spica-cast.html

It took some time, but my son found a position that was comfortable and was able to sleep. He did move around, however, so don't be surprised if your child does this too. We all like to shift during sleep.

Anonymous said...

My two year old broke her right femur at the sitters five weeks ago. She fell on the hardwood floor and twisted her body the wrong way...such a freak accident. Our life has been turned upside down with the hip spica cast. She is honelty doing better then her father and me. It will all be over within a week or two and then we move on to therapy. I appreciate you posting your story for others to read. Thank you!
-Mother from KY

Les Jacobs said...

Thanks for your comment. Yes, it was a big strain for my wife and me too, when Akira was in his cast. Hang in there. There's a light at the end of the tunnel, and you, your spouse and your child will all have learned a lot from this experience.

One of my other sons -- who didn't break his leg -- told me something the other day about his perspective during the whole Akira-in-the-spica-cast ordeal. He and his brother slept upstairs in their bedroom while Akira was downstairs in the living room, sleeping on a mattress set up for him (too dangerous to bring him up and down the stairs every night and morning). My wife and I would sleep next to Akira downstairs, in case he had any special needs during the night.

Anyway, Akira's brother told me he was jealous. He wanted to be downstairs sleeping next to Momma or Papa, instead of in his bedroom. This is ironic, because during the whole experience Akira wanted to be upstairs, in his brother's bedroom!

mery julca said...

to come back amd they will removed it that will make it 4 weeks total.
Im a lil worry because every. Ase I read said their kid had it for 6 weeks or more.
Did you son xray, did his fracture look fully heal or the fracture was still showing, so I know what to look for nwxt week that we have to go back, so they suppose to will removed her cast.
Thank you

Anonymous said...

Has anyone had experience with a 7 month old in a spica cast? My son fractured his femur last week and I have scoured the Internet but can't find much re: infants and spica casts. I am scared to hold him in certain positions, am curious how long he will be in the cast and how soon after its removed will he be fully recovered? Any advice or experiences would be very much appreciated.