Hip Spica Cast: What to Expect

If you think you're busy as a parent of triplets, wait until one of your children breaks a leg and ends up in a hip spica cast.

On June 20th, 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