Hip Spica Cast: Info for the Worried Parent

Child Crying During Physical Therapy, After Cast Removal

2011-05-26T17:13:00.004-04:00

Hi, Les,

This blog of yours is so good because we can share with each other the experiences we have with our kids.

I have a son named Kian. He had hip dysplasia, and underwent major surgery to his right leg. He was in a hip spica cast for 2 months, and they took off the cast last week.

The orthopedist advised us to take Kian to a physical therapist (PT) to help him recover the use of his right leg.

Today he had his first session and he cried out, saying it was painful for him.

My question is: Is it normal to force him to straighten his leg or even move it?

For us moms, it pains us to see our children getting hurt.

The physical therapist told us to come back every day to the clinic.

I just want to know, Les: did your PT allow you to continue your son's exercises in your home?

Thanks,

Karen from the Philippines

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Dear Karen,

I just want to say I visited Manila once and loved it. The people were extremely friendly, I rode in a Jeepney, and was amazed at how beautifully Filipinos can sing. I went to an outdoor karaoke party and a girl from the audience stood up and sang a song with notes higher than Mariah Carey! Amazing.

To answer your questions:
My son's orthopedist told us not to straighten his leg. We were told that my son would straighten his leg on his own, and he did, the first night he was home (he did it in his sleep).

What I am wondering is why your son hadn't straightened his leg after being home a whole week. My boy was eager to play with his brothers, so this motivated him to get up and start running around (this took a long time, however: the running around).

Does Kian have any siblings? Did you take him to a park or to a relative's house so he can see other kids running around? This may motivate him to get up and get moving.

But I don't want to give you medical advice because I'm not a doctor. Ask your physician or your son's orthopedist if it's normal for a hip dysplasia patient not to straighten his leg after being home for a week. Perhaps for your son's condition this is normal. I don't know.

About doing physical therapy in the home, I don't know if that is offered where you live. I know it is very expensive here. What we did -- as we really couldn't afford to take our son to the PT every day -- was ask for a list of exercises from the physical therapist (with pictures describing how to do them), and I put my son through the exercises every morning myself. (I then took him to the PT once a week just to make sure I was doing the exercises correctly and that my son was making progress.)

Is it normal for a PT patient to cry out? I asked my PT friend this question and he said, "It depends." With children, he said, oftentimes they scream or cry out more because of fear rather than pain. "The way to check if any damage was done to the child is to see if he has less range of movement after the session than before," my friend said. Or, if your child can move around (crawl perhaps), was he less able to do this after the session? Has he complained about pain since the session?

I know with my son he was terrified immediately after his hip spica cast was removed, just because the weight he had gotten used to was gone. In fact, he cried very loudly after the cast removal, and this was solely out of fear.

He never cried once during the physical therapy, however, although he did complain about his leg being "tired" (which probably meant his leg muscles were sore).

Again, ask the orthopedist whether the way your son is reacting is normal. It's always good to get a second opinion in matters like this, especially if your son might be experiencing real pain.

Les

Moving Around with the Cast and After Cast Removal

2011-01-11T17:19:00.002-05:00

Les,

I was curious what your and other readers' experiences were when a child will start to walk post-cast removal. My son's cast went to his ankles in both legs and we are 6 days post-cast.

He started scooting on his bottom after about 4 days, crawling about day 5 with a bit of limited standing (while holding and we have to put him in the standing position). He definitely has more movement in the "whole" leg, and won't really bend the right leg that was broken.

Our doctors said no physical therapy is necessary so I have read your posted exercises with interest and will be taking Ned to a therapy pool a few times a week until I return to work. Also, as a multiple, his sister can push him to do more - he will get annoyed with her and try to take away toys and/or chase after her (crawling) if they are having fun.

Last night he even crawled up into her toddler bed. Did you notice the same thing with your boys?

As an aside, my son NEVER learned to crawl in his cast or move around at all other than a little spinning on his back when we changed his diaper. He didn't even like to spend much time on his stomach and couldn't lie on his side. I suspect that is because it was a rather reclined cast and went down to his ankles.

I also wonder if this means he will be slower to recover from his injury since he was very inactive during his 5.5 week cast time. I know you had much more movement out of your son but I wanted to present another experience for your readers.

We were told that he had the cleanest spica cast they have ever seen - probably because he didn't move around much.

Best regards, Mommy, Esq.

Read about the removal at: http://www.mommyesq.com/2011/01/cast-is-past.html

Hip Spica Questions: Meal Times, TV, Winter

2010-11-30T08:07:00.007-05:00

Hi, my son (2.3 years old) just had a spica cast put on and he'll be in it for at least 5 weeks. I've appreciated the questions and answers you've provided but had a few additional ones:

- Eating. Obviously the high chair is out. My son is a difficult eater to begin with (read: toddler) but I want to try to keep his meals as nutritional as possible. He is also a decently neat eater but of course being 2 it is all relative. What did you feed your son and where? How did you try to head off the mess?

- Limiting TV time. My son has a twin sister and a 6 month old sister and therefore my attention is divided. How to keep the TV from becoming the focus of our lives?

- Winter: Your son was in his cast during the summer but we are handling this during the wintertime. Any advice from other readers as to what to wear and ways to get out?

You can find us on mommyesq.com.

Thank you!

Mommy, Esq.

Dear Mommy, Esq.,

You have beautiful children, and I'm very sorry to hear Ned broke his femur. To answer your questions:

Feeding:

What we did with my son when he was in a hip spica cast was put him in a recliner that was pulled out enough so he could lie on it, but at an angle, so that he was still sitting up. We fastened a large plastic bib that covered his whole body, and draped towels over the arm rests and on the back of the recliner (in case he spilled or threw food). Then we put his food on a tray that was placed across the arm rests in front of him. He wasn't at the kitchen table, but he could see it from where he was in the living room, so he still felt he was part of the family meal. One of us (my wife or I) had to sit with him, in case he needed help.

TV:

Put him on a mattress on the living room floor and give him reading materials and toys within reach. If you want him to be mobile, do what this inventive parent did and build a "spica cast skate board." (To see a video of the patient actually using it, watch the video at the end of this post.)

Winter:

You've got to get out, and so does he, or you'll both go stir crazy. Try to do this every day. Buy or rent a wheel chair (insurance will cover it) and go to the nearest mall where you can push him around. He will appreciate it and you will be able to stay sane.

Re nanny:

You're going to need one person to stick with Ned at all times. This includes sleeping in the same room with him at night. (I cared for him during the day; my wife slept next to him at night.) Night care is necessary b/c you'll want to flip him and/or help him shift positions so he doesn't get bed sores and suffer other discomfort.

Yes, the extra childcare will be expensive. Be thankful it will only be for 5 weeks. For us it was 7.5.

Hang in there. The good news is that with more one-on-one time with your son (for you and your hubby, who should help out when he can), you will develop an even closer bond with him.

Les

After the Spica Cast Comes Off

2010-09-22T14:54:00.000-04:00

Dear Les,

I just can't thank you enough for the information you've provided me with. I've been searching the Web like crazy, and most of the stuff I've read is irrelevant!

My son also fractured his femur, but it was due to a bone cyst that he was apparently born with, but that we didn't know about until he had his fall.

He had an operation where they fixed a plate and 8 screws. It has been exactly one month since he had the operation and hopefully we will remove the cast within the coming two weeks.

However, I'm so worried about the coming phase, which is him without the cast. I don't 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 his old self.

He is 5 and a half, by the way. I hope your son is doing great now.

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

Sasha

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Dear 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 as we wheeled him out of the surgeon's office. 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--and we had to pay it on each visit!--so I asked for a list of the exercises from the PT and put Akira through them 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 near him in age, 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.

Hip Dysplasia Questions

2010-09-07T09:46:00.000-04:00

Dear Les,

My husband and I just found out our two year old daughter has hip dysplasia and will need surgery. I would love to hear from other parents on a few questions:

1. Did you have x-rays taken of the spine and ankle of your child to make sure they were not misaligned as a result of hip dysplasia? This is a concern of mine.

2. Is traveling in a car with a child in a spica impossible? I mean, we would have appointments of course, and would need to get our daughter home after her surgery. What did you do when traveling in a car?

3. How were you successful in preparing your child for surgery?

Thank you,
Maiden Mom

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Dear Maiden Mom,

My son did not have hip dysplasia--he fractured his femur--so I know very little about this condition. But I will try and answer your questions as best I can (and hopefully other parents whose children have hip dysplasia can add insightful comments of their own).

1. This sounds like a question you should ask the orthopedic surgeon who will perform the operation.

2. Traveling in a car with a child in a hip spica cast is definitely not impossible. Our son wore a spica cast for seven and a half weeks and we took him to and from the doctor's office and physical therapy clinic in our car repeatedly. He was three years old. What we did was lie him down in the back seat, supported by pillows, and buckled him in place with seat belts. One of us (usually me) sat next to him and made sure he stayed in place. We (usually my wife) drove slowly and carefully.

If you'd rather not do this, or can't, you can buy car seats specifically designed for kids in hip spica casts. There is an example at this website. (They aren't cheap, but your insurance may cover part or all of the cost.)

3. Again, my child didn't have hip dysplasia, but he was put under so that the cast could be put on. I didn't do anything special to prepare him for the procedure, but stayed by his bedside until he was wheeled into the operating room and smiled and laughed a lot to keep him in high spirits. The nurses were also very sweet. They gave him a toy to play with and took his picture (before and after pics were taken). They helped keep him laughing until it was time for the cast to be applied.

What is critical is that you or your husband (or caretaker) be available immediately after the surgery. Once my boy awoke from the anesthesia he asked for me immediately and was very upset. He was sobbing and disoriented, and it was essential that I was there to comfort him. I did my best to hold him and soothe him until he cried himself to sleep.

I hope parents of children with hip dysplasia can add their comments to this post.

Wishing your daughter a problem-free operation and a smooth recovery,
Les

CastCooler Testimonial

2010-06-08T22:44:00.000-04:00

A testimonial from a reader who has used the CastCooler product:

When we opened the cast cooler, we were really skeptical. From the first time we tried it, we were convinced. My 7 year old special-needs son is non-verbal. The look on his face when he felt the air through his cast was worth more than words.

Apparently it was quite soothing, as he fell asleep while it was on and had the most restful nap he had had since the placement of his spica cast. Since we began using the cast cooler, we have also noticed a significant decrease in the smell of his cast. Being able to circulate fresh air through his cast is indeed a wonderful thing.

We cannot thank you enough for creating this product.

-Lori

Son Won't Bend Leg After Spica Cast Removed

2010-04-26T17:23:00.000-04:00

Hi,

My son is just two years old. He was in a hip spica cast for four weeks and in leg traction for two and a half weeks in hospital.

His plaster came off this Tuesday, Nov. 11, but his leg is still as stiff and straight as it was when it was still in the plaster (cast). He is not bending it at all.

I am massaging it regularly and giving him a warm bath daily, but he is still very scared to use or bend his fractured leg. Can anyone tell me, please, what I can do to encourage him to bend that leg?

If anyone could guide me about simple exercises I can do with him to help him, I would greatly appreciate it.

Thank you,
Sabiha

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Dear Sabiha,

When the surgeon took off my son's cast, he told us specifically not to bend the leg, and to let my son bend it on his own. It can be very painful to bend it, he told us, so we were to let our son bend it when he was ready to do so.

In the case of Akira (my son), he bent it while he slept that first night after the cast (plaster) came off. But it was several days later before he even tried to stand up.

One thing that spurred Akira to bend his leg, stand, and finally start walking (and eventually running) around was seeing his triplet brothers running around. He wanted to join in the fun with them.

Does your son have siblings close to him in age? If so, make sure your son sees them playing. If he doesn't have brothers or sisters, perhaps he has cousins or friends his own age? Or take him to a public playground so he can see other children his own age having fun. This should eventually encourage him to move.

If this doesn't help, then I would suggest you take him to a physical therapist. Ask the orthopedic surgeon who put on the cast to recommend one (my son's surgeon recommended the physical therapist we used for Akira).

I hope this helps.
Les

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Hi again,

Thank you so much for your advice, it was really helpful. I did exactly what you said: I took him to my cousin's house who has three children and Zia started walking and playing with them.

It's been more than week since the plaster (cast) came off, but still he has a limp in his walk. Also I have noticed he is walking on the side of his foot (the foot of the leg that was fractured).

I want to know if it's normal to have a limp at this early stage, and how long it took for your child to walk normally after his hip spica cast was removed.

Thanks again for your tips.
Sabiha
Nov. 20, 2009

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Sabiha,

I'm so glad to hear your son is up and around now. The limp is totally normal.

With regard to walking on the side of his foot, you may want to take him to a physical therapist and ask what you can do about that, just in case braces or corrective footwear is required.

Again, don't worry about the limp. My son didn't fully recover from his broken leg until 6.5 weeks after the cast (plaster) came off. And even at that point, he had trouble climbing stairs and walking long distances.

Remember, Zia has been inactive for six and a half weeks. This means his leg muscles have atrophied, and it will take time for him to rebuild strength and stamina in those muscles.

Be sure and have Zia do leg-strengthening exercises every day. I put my son Akira through 15 to 30 min. of such exercises on a daily basis, and it really helped.

Meet with a physical therapist and have him/her give you a list of exercises to do. Be sure the therapist shows you how to do them, then, after having your son do them at home for a week or so, go back to the therapist to make sure you have been doing them correctly. This is what we did with my son.

The other alternative would be to have the physical therapist put your son through the exercises, but this can be expensive (for us it cost US$50 per visit!).

For more on Akira's experience and what we did to help him recover, see this post.

Les

A Little Girl's Hip Spica Cast Experience

2010-04-01T19:25:00.000-04:00

Ali's 3.5 year old daughter, Menat Allah, in her hip spica cast.

Dear Les,

Your blog was a great help for my family, thus I want to contribute. I suggest you add more X-rays to show different cases and how long it took to heal.

I will start by sending my daughter's X-rays (aged three and a half when she broke her leg); her name is Menat Allah (meaning, "gift from God"). She was in a hip spica cast for one month, but she didn’t stand up until two weeks after the cast was removed.

How did she break her leg?

I feel really bad when I remember this. I was playing with her and pushed her a little too hard. She fell down and landed on her leg, which was twisted in an awkward position. We were playing on the blow-up toy below.

Our home in Saudi Arabia (where I work) is far away from the nearest city (100 km/62 mi.), and the emergency clinic I took her to advised me to take her to a hospital in the city. So I drove my daughter there, and on way she screamed very loudly for about 45 minutes, and vomited.

When we arrived they performed an X-ray and told us that her femur was broken, and that we had two options:

(1) to perform an operation and use “nails” to fix her leg or
(2) put her in a hip spica cast.

I, of course, told them to put her in the cast.

After applying the cast, the doctor told me that if Menat Allah were his daughter, he would have given her the operation and used nails. The operation would have made sure she was OK, he said.

"It's a very simple operation," he added.

The doctor's comments worried me, so I asked a lot of other doctors their opinion. One of them said the break is in a good position but it would have been better to use nails to fix my daughter's leg.

I didn’t want her to go through an operation, and your website helped me with my decision.* I saw some X-rays and the bones were broken in almost the exact same way my daughter’s femur was.

I sent my daughter's X- rays to a doctor in my home country, Egypt, and he told me, "Don't worry, your daughter will be OK. There is no need for an operation."

The Healing Period

Menat Allah stayed in a hip spica cast for exactly four weeks. When the doctor took it off, I was worried, because I knew the healing period is normally six weeks; but I was happy as well.

Because the cast was on for such a short time, I didn’t push her to stand after the cast was removed. I let her lie for another two weeks. After that she started to crawl, and then she started to walk with our help.

She now walks very well, but not 100% normally, but I think in two months or so she should be all right.

To summarize:

She was in the cast for 4 weeks.
After it was removed she did not move for 2 weeks.

I sent you my daughter's X-rays because I think this will help other worried parents suffer less of a shock when they first see how their child's bone has broken. I want to comfort these parents and let them know that although the break looks bad, their child can still heal and become well again.

I also included a picture of my daughter playing in a cast. The first three weeks Menat Allah was in the cast was very, very difficult for us all. It wasn't until the fourth week that she stopped crying and had no pain.

-Ali

What follows are the X-rays of Menat Allah's femur that were supplied by Ali. Each is labeled.

Day 0 - before cast was applied

Day 0 - before cast (different angle)

Day 0 - in cast

Day 0 - in cast (different angle)

After 2 weeks

After four weeks (1)

After four weeks (2)

It was this last X-ray that convinced Ali not to have his daughter start walking right away. He emailed a copy to his doctor in Egypt and the physician agreed with Ali that it would be best that Menat Allah stay in bed for two more weeks.

Ali was going to get another X-ray at the six-week point, but didn't after Menat Allah began standing up and walking. In fact, she is now jumping up and down and climbing stairs.

* NOTE: I am very happy things worked out so well for Ali and his daughter. I would like to stress here, however, that I am not an expert and can in no way advise parents as to whether they should have their child undergo an operation "with nails," or, alternatively, have a hip spica cast put on.

When Ali read my website, I hope he didn't get the impression that I am advocating for children to wear the hip spica cast instead of undergoing an operation. A physician is the best person to make such a decision, not I.

-Les Jacobs

Physical Therapy for Hip Spica Cast Patients

2010-01-29T13:51:00.000-05:00

When a young child suffers a broken hip or thigh bone and must wear a hip spica cast, this can be a very trying time for the toddler and his parents. The child may not understand why he has to put up with so much pain and be confined to the hip spica cast. All he wants to do is get up, run around and play with other children.

The best way for parents to deal with a child’s injury of this sort is to explain as best you can the treatment that is being provided, and make him as comfortable as possible. When your child is in a hip spica cast, you need to ensure that:

• The cast does not pinch his skin or cause him pain or discomfort in any way.
• The cast is dry and fresh at all times.
• Your child is turned over at least once every six hours to prevent the onset of bed sores.
• Your child’s bedding is absolutely clean and changed regularly.
• Your child does not stand or bear weight on the cast.
• There is no rash due to itchiness caused by the cast.
• You child has normal feeling in his toes and lower limbs and that blood flow to the lower extremities is normal.
• The cast does not develop any cracks or dents.
• Your child is comfortable and entertained at all times.
• Your child does not put any object down the cast.

When your child has recovered and it’s time for the cast to come off, his limbs will be stiff and unresponsive after the prolonged period of immobility. While some doctors may skip physical therapy altogether, others prefer to provide a set of exercises that will help your child regain full range of mobility in his limbs. Each physical therapy program is tailored to the child’s particular injury and the treatment needed. In general however, doctors recommend that:

• The thigh muscles are strengthened with leg lifts – your child should lie flat on a bed or hard surface, and lift each leg alternately as high as he can without bending his knees, hold the position for a few seconds, and then slowly bring it to rest on the bed. A few repetitions with both legs should be done every day.

(NOTE: Your child may be very afraid once the hip spica cast comes off. Having gotten used to the heavy cast, it can be quite traumatic for a 2 to 5 year old to suddenly have all that weight disappear. Take a pillow with you and have it ready to put on top of his legs immediately after the cast is cut off. This will help calm him. Also, do not do any of the leg-lift or other exercises until after your child's fear has subsided. This may take a few days.)

• Your child should walk as much as he or she is able to once the cast has come off. (But let the child let you know when he's ready to do this. Don't push him.) Some children are wary of putting their feet on the ground because they are numb initially and may have no balance. (One way to encourage him to get up is to have him watch other children his age at play. Bring friends or relatives over, or visit a local park or playground.)

• Once he's able to walk straight without any help, get him to walk sideways and then climb up and down stairs. (Start slowly and be very patient. Your child will most likely complain, loudly.)

IMPORTANT: Talk to your doctor before you have your child do these exercises or any kind of at-home therapy. It is also highly recommended you consult a physical therapist, as such a professional will be able to suggest and tailor exercises to your child's specific needs.

Be careful, as pushing your child too much, having him do improper exercises, or improperly doing correct exercises may result in further injury or harm to your child.

By-line:
This article was written by Shannon Wills, who writes on the topic of Physical Therapist Assistant Schools. She welcomes your comments, and can be contacted at shannonwills23@gmail.com.

Curing a Hip Spica Cast Rash

2009-12-04T11:45:00.000-05:00

Our grandson of 22 months broke his femur on Halloween night. Stepped off a curb into a pot hole and received a twist fracture.

A 22 month old in a cast from his waist down has not been a breeze for his Mom and Dad. He began to break out in a terrible rash underneath his cast within the first week.

I started searching for anything to bring him relief. I came upon the cast cooler and ordered one immediately.

When it arrived, we were very nervous about it at first - would he be frightened or traumatized by attaching him to a vacuum cleaner? The very first time we used it the poor baby feel asleep.

Within the 4th use, his rash was completely gone!!! He now asks for it when he begins to itch. He says, "Vacuum, vacuum!!"

This invention has made a very hard situation tolerable. My grandson now has only 2 weeks left in his cast and he is comfortable and as happy as a 22 month old can be in a cast.

I highly recommend this for other parents or grandparents who have a tiny loved one in a cast.

Kelly

Exercises After Hip Spica Cast is Removed

2009-11-20T19:37:00.000-05:00

Hi Les!

I just want to know what type of exercises the physical therapist recommended for your son Akira. My son's hip spica cast has already been removed. Please advise.

Thank you!
Rb

--

Rb,

First of all, please note that according to The Children's Hospital & Research Center Oakland (California), "Most children do not need physical therapy to walk or move normally again. Routine activities and play is usually enough for children to return to normal within a few months."

That said, our orthopedic surgeon recommended our son see a physical therapist (PT) after his hip spica cast was removed, and the Children's Hospital does recommend that you "have the child move the healing extremity through all of its motions, using the other arm or leg to judge what normal is. Children who do not regain normal motion after a month or two should be rechecked."

Akira's PT put my son 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 the exercises 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 your child's progress. That's what we did (to avoid the crippling US$50 per-visit fee) and it worked.

You may find this list of exercises from McGill University Health Centre to be helpful.

Son's Leg Shorter After Wearing Cast, What Do I Do?

2009-11-11T20:47:00.000-05:00

Les,

Thank you for setting up this web page. It has been very informative and somewhat reassuring. My 18 month old has just had his hip spica removed today after 7 weeks. He fractured his right femur after a fall.

Since bringing him home from the hospital today, I have noticed significant leg length discrepancy - the injured leg is shorter by approx 2cm. Did your child have this?

I spoke to the doctor who said it is normal and the bone will eventually realign. This just doesn't sound quite right to me - 2cm seems a lot. Any views you may have will be greatly appreciated.

Thank you
Sid

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Sid,

Sorry to hear this happened to your son. This did not happen to my son. In fact, I remember asking the surgeon about the possibility of leg shortening and he told me leg lengthening is a more common problem! (Apparently, the healing required to fix the broken femur spurs growth in the bone.)

I did a little research to answer your question, though. But please bear in mind I'm not a physician - just a parent like you whose son wore a hip spica cast.

According to a paper written by Dr. Merv Letts at the Children’s Hospital of Eastern Ontario, "Radiographs should be taken at weekly intervals to detect shortening or angulation. If shortening occurs to the extent of 2 cms or more, the child should be taken out of the hip spica and 90 - 90 skeletal traction instituted through the distal femur."

In other words, they should have been taking x-rays regularly (as they did with my son) to make sure such shortening wasn't happening.

The critical question here is the precise amount the healed leg is shorter. From what I've been reading, if it's 2 cm or more, this may be a problem, and you may need to take corrective medical action (ask your doctor or get a second opinion, of course). If it's less than 2 cm, however, it may be OK.

According to Dr. Ernest L. Sink, who published a paper on the American Academy of Orthopaedic Surgeons website (aaos.org), if the child’s injured femur is only 1 cm shorter, "this amount of shortening typically corrects with overgrowth in the first year after injury." (And this was for a 5 year old.)

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

2009-10-01T18:08:00.000-04:00

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

2009-08-16T14:40:00.000-04:00

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

2009-08-06T15:44:00.000-04:00

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

2009-07-28T09:14:00.000-04:00

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

2009-07-23T10:54:00.000-04:00

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

2009-07-14T09:49:00.000-04:00

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

2009-05-23T19:39:00.000-04:00

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

Is it Easier if the Hip Spica Patient is in Diapers?

2009-03-26T11:03:00.000-04:00

A reader asks:

My daughter was born with Developmental Hip Dysplasia and is having surgery in 2 weeks. She is 18 months old & I've been tearing my hair out looking for help. Thank you, thank you, thank you.

Wondering if you could answer me this ... do you think it is harder or easier in the cast if bubby is in nappies?

-Leanne

---

Leanne,

Our son Akira was not toilet trained when he wore his cast, so he was in diapers the whole time. Would it have been easier if he hadn't been in diapers? I don't know, but I can't imagine it would have been.

The cast forced Akira to keep his legs straight and his body unbent; he had to lie flat. How does one negotiate a bedpan in such circumstances? You'd have to lift him, I'd guess, and keep him suspended over the bedpan while he does his business.

Akira weighed around 35 lbs. when he broke his leg. With the half-body cast he weighed closer to 50 lbs. Can you imagine trying to lift that much weight every time he needed to go pee pee? And what if you accidentally dropped him, or he inadvertently sprayed his cast?

Not that caring for a spica-cast patient in diapers was a walk in the park. The danger we faced was that the diaper would leak, either because it was ill-fitting or full, and then the cast would get stained. So we had to check the diaper often, and make sure it was always in place.

One method I've seen that has been recommended is to have the patient wear two diapers. The first diaper, with sticky tabs removed (otherwise they stick to the inside of the cast), is against the skin, over the buttocks and groin, with the ends shoved up inside the cast, in front and behind. (Or you can use a sanitary pad instead.)

The second diaper is worn over this one, but is fastened on the outside of the cast using the sticky tabs. So the outer diaper works to keep the inner diaper (or sanitary pad) in place. You may need to use a larger diaper for this outer one.

For pics on how to do this, see p.2 of this link (it's a PDF file, so give it a minute to download): http://www.vanderbiltchildrens.com/uploads/documents/ortho-hc0425.pdf

When our son first had his cast put on they had him wearing only one diaper, which was fastened on the outside of the cast (as in the second diaper mentioned above). There was no diaper or sanitary pad underneath!

This was, of course, a disaster b/c if he had wet himself it almost certainly would have stained the cast. We saw that immediately, cut the tabs off and shoved the ends of the diaper up under his cast.

Moral of the story: nurses don't always know what they're doing with hip spica cast patients, so you've got to oversee things yourself.

13 Hip Spica Cast Questions Answered

2009-03-19T11:20:00.000-04:00

I have a 5-year-old who'll soon be in a spica cast for the 2nd time (Kyle was born with congenital hip dysplasia). This time will be so different from his casting as an infant. I just want us to prepare ourselves for what's around the corner - as much as anyone can prepare themselves for this sort of thing.

M.

1. Activities in the cast - do you have ideas for me?

M., I put my son in a wheelchair (see pics on this website) and took him for a walk every day. At home I made sure his favorite toys/books were within arm's reach. I read to him every day and was a little more lenient when it came to TV watching. Note that he's not supposed to be mobile during the first week or two (after that he'll move around whether you want him to or not) so it's best to have him do sedentary activities.

2. Over the course of six weeks, did you get out much?

- I made a point of getting out of the house every day, when I took him for walks in his wheelchair. You have to do this or you will go stir crazy. So will your child.

3. What did you have your child wear, most of the time? I remember customizing over-sized shorts for Kyle, when he was in a spica as an infant. Any advice on attire?

- He wore nothing over his cast while he was in the house, but we did cover his cast with a light towel when we went out. It was mid-summer and very hot when he wore his cast, so we wanted to keep him as cool as possible. (It's very hot under the cast.) We ran the air conditioner in the room where he stayed (our living room) and went for walks early in the morning, when it was relatively cool.

4. Hospital advice. I get stressed in post-op/recovery. Anything important you could pass on to me - from your own experiences?

My son woke up from the procedure crying. Be sure you're there to comfort him. Don't be surprised if you're asked the same question by different doctors and nurses (and some may even do so with an accusatory tone): "How did your son break his leg?" They will ask your son the same question. If it sounds like they're trying to figure out whether you abused him, don't be surprised: that's exactly what they're doing. It's their job. They're watching out for the welfare of their patient. Don't take it personally.

Make sure the diaper is properly in place. The nurses fastened the diaper on the outside of our son's cast, which would have resulted in a messy disaster. We cut off the sticky tabs and shoved the diaper ends up under the cast, front and back. Just make sure it doesn't slip out when your son moves around.

I would recommend you place a sanitary napkin over his crotch and bottom, then put a diaper over that. With the sanitary napkin next to his skin, you can then secure the diaper around the outside of the cast, but make sure it's a size or two bigger than the diaper size he normally wears.

While in post-op and in the hospital (they may observe him for a day before they let your son go home, to make sure there are no complications from the anesthesia) change his diaper every hour or so. The nurse is supposed to do that, but the way hospitals are so understaffed nowadays, don't count on them. Also, shift your son around every 2 hrs or so, so he doesn't develop bed sores.

5. I wonder whether Kyle will settle for lying down for 6 weeks - or if he'll try to stand/walk, even. I think his cast - this time - will enclose one leg to his toes - the other to his knees. This time it will not be a sitting cast, it will be straight. Is this anything like your child's? Having that much more weight - I don't know that I'll be able to get him up stairs - may have to relocate his bed for a while.

Relocate his bed downstairs. You do not want to be going up and down stairs every day. You'll probably hurt your back doing that, but, more importantly, you may drop him on the way up/down, which could be disastrous. We had our son stay in the living room downstairs. Inconvenient for us, yes, but safer for him.

Kyle's cast sounds exactly like my son's. Your son will NOT settle. He will probably be immobile for the first week or so and may complain of pain. This is normal, as it will hurt where the bone broke. But he will slowly get used to the cast and will become VERY mobile, believe me.

Kids are unbelievably adaptable, as I'm sure you know, and Kyle will start treating his cast like another appendage. Our son, Akira, flipped his up and around like a mermaid ("mer-boy"?) with a concrete tail. Be careful around him when he does this, as he can hurt you with that heavy cast. Our babysitter narrowly avoided having her foot crushed when he lifted his cast and slammed it down one day.

If Kyle is anything like our Akira, he'll eventually try to crawl around, crawl up the stairs, and stand up. Discourage the standing and stair-climbing, of course - and make sure you keep an eye on him at all times - but we let Akira scoot around the room and even spin in place on his cast (on the carpet). He liked to do this to music.

Your son will want to have fun and it'll be cruel to deny him some mobility. (At least that's my view. Our doctor was horrified when he heard we let Akira move around the last few weeks, but our son healed fine anyway.)

6. Did your child opt for "diapers" or bedpan or toilet? I can't imagine the toilet will work - for solid waste, since he'll not be able to bend and sit.

Akira wasn't toilet-trained, so he was in diapers. Ask your doctor or nurse how to manage the toilet with your son, as I can't really answer this. (Perhaps visitors to this site can help with some tips?)

7. Did he need to be flipped over throughout the night - to prevent bedsores? Could he flip on his own? Or, did he need help?

After the first few days your son will probably start moving around at night. Before then, he will probably wake up crying from discomfort or pain. My wife and I took turns sleeping next to him and moved him whenever he complained. As your son gets used to the cast, he'll move on his own at night and shift into positions he finds comfortable. Akira's favorite sleeping position was with one leg sticking up as shown here:

8. Did your child become discouraged or frustrated? I don't anticipate that with Kyle - but, maybe I'm naive not to.

Our son complained at times and became weepy when he couldn't join his triplet brothers in their bedroom or participate in other activities they were doing. We had to comfort him and distract him with other activities when this happened.

9. Did you do PT after removal? A walker? No bracing, I guess.

Akira wasn't able to bend his legs until the day after the cast came off. It was a few days later that he was first able to stand. Yes, we took him to a physical therapist. Because of the prohibitive cost ($50 co-pay per visit!), however, I put him through his exercises at home every day instead of having the therapist do it.

We visited the PT three times. The first time to get the list of exercises. The second time to make sure I was doing them right. The last time to make sure he had progressed enough to "graduate" from the exercise regimen. This took about 7 weeks, total, but he still walked haltingly up and down stairs and couldn't manage long distances even after all this. He did recover fully, eventually, however.

BTW, our son was 3 when he broke his leg and had his spica cast put on, so your son, being older, might take longer to heal and recover. Every kid is different, of course. Also, don't be surprised if Kyle has to wear his spica cast longer than 6 weeks. We were initially told 6 wks and the doctor extended it.

Akira did not use a walker or have special bracing put on his legs.

10. Was there a lot of muscle atrophy?

Yes, which is normal. Akira's leg was noticeably thinner (and strangely hairy) when the cast came off.

11. Was it difficult to keep the cast clean? It definitely was, as an infant.

Yes, you'll find out how we did this here: http://hipspicacast.blogspot.com/2008/12/keeping-hip-spica-cast-clean.html

(If you have more questions on this, pls let me know.)

12. Was cast removal frightening for him? And, what was recovery like after the cast was removed?

Yes, Akira was very frightened when the cast came off. The doctor told us not to bend his leg (we kept him in a prone, lying down position on the wheelchair when we left the doctor's office and put him in the car - laying him down on the back seat). Putting a pillow or two on his legs made Akira feel better.

The recovery took about 7 weeks, but it was a good three months before he walked and climbed stairs the same as other children his age.

13. How did siblings respond to all of this?

They were jealous b/c of all the extra attention Akira was getting. I remember taking Akira's brothers to the park a week or so after he broke his leg. Instead of running around and playing, Hideki and Ichiro lay on the grass and appeared to be lounging. It took a minute for me to realize they were imitating their brother. They obviously thought pretending to be lame would get them all sorts of special treatment!

They did adjust eventually, but my wife and I had to give them each some individualized attention at times to help even things out. (Explaining things to them didn't help much as they were only 3 and didn't really fully understand.)

Hope this helped. Feel free to send me any more questions you may have.

Hip Spica Cast: What to Expect

2008-12-10T10:02:00.000-05:00

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

Child Care & the Hip Spica Cast

2008-12-10T09:57:00.000-05:00

Your child may find this to be a comfortable sleeping position.

If your child is 2 to 3 years old and in a hip spica cast, be prepared for a lot of extra work.

Our 3-year-old son Akira broke his left femur this summer and was in a fiberglass hip spica cast -- that encircled his waist and both legs -- for seven and a half weeks. (See "Akira Broke His Leg.") I personally took care of him and hired a babysitter to look after his triplet brothers. This was a burdensome expense, but there was no way to avoid it. Here are some care-giving tips based on our experience:

1. Watch the child at all times. Someone should be assigned to care for him, and him only, the entire time he's in the cast. There are several reasons for this:

a) He may stick toys, utensils or other objects down the cast. He might do this to scratch an itch – hip spica casts can get hot, and your child will sweat – or just for fun. If things get lodged in the cast, this could cause extreme irritation, break the skin and ultimately result in an infection. The only way to remedy this is to remove the cast, which means a new one will have to be put on.

Besides being a huge hassle for you and your family, this could also be putting your child at risk. As patients, 2 and 3 year olds tend not to be cooperative and are usually put to sleep for the application of a hip spica cast. Whenever general anesthesia is administered there is always the possibility -- however remote -- that the patient could die.

b) He might accidentally re-injure himself. After Akira had healed for a few weeks and built up some upper-body strength, he kept trying to drag himself across the floor. We once caught him trying to pull himself up the stairs. Another time Akira attempted to stand up. In both cases he could have suffered a fall, damaged the cast and hurt himself.

c) He may drop food or pour liquid into the hip spica cast. Because you can't clean the interior of the cast, this could necessitate the removal and reapplication of the cast. Your child may also eat something that gives him diarrhea, which may run down into the cast. (See "Keeping the Hip Spica Cast Clean.")

d) His diaper needs to be checked often. If he is not toilet trained, as my son wasn’t, he'll have to wear a diaper. If the diaper gets full and leaks it will overflow and soak into the lining of the hip spica cast. We checked Akira’s diaper every hour. I once went two hours without checking him and his diaper leaked. His cast smelled like a public urinal for days afterward.

You should also check frequently to make sure the diaper is on properly. We found the best way for Akira to wear a diaper was to shove the ends up under the cast, instead of fastening it around the outside. The drawback with this method is that the diaper can slip out if your child moves around too much. (The disadvantage of fastening it on the outside of the cast is that the cast is then more likely to get soiled.)

2. Keep the child cool. Because it encircles the waist and both legs, hip spica casts can get very hot. It was summer when Akira had his cast put on, so we had the air conditioner set at 76° F (24.5° C) and running day and night in his room (the living room).

3. Keep the child downstairs, if possible. Akira’s bedroom is upstairs, but the nurse advised us to set up a bed for him downstairs, as we might drop him carrying him up and down the steps. This also avoids a situation where, being upstairs, he may try to drag himself downstairs, and hurt himself doing so.

4. Bathe your child every day. This is necessary because children sweat a lot wearing a hip spica cast. To keep his cast dry during the bath, we laid Akira on a plastic sheet placed on a bed and wiped him down with a damp washcloth. To wash his hair -- which we also did every day -- we had him lie on his back and hang his head over the side of the bed (the plastic sheet hung over the side too, under him). We then shampooed and rinsed his hair, using as little water as possible, over a plastic storage container -- which you can find at any Wal-Mart or Target. This was a long and involved bathing process at first, but once I got the hang of it I was able to do it in under 20 minutes.

5. If your child needs a pain reliever -- Akira did the first few days -- give him Children’s Tylenol, not Children's Advil. Akira's post-op nurse told us that Advil may interfere with the healing process, so Tylenol is the preferred pain reliever. She did not offer an opinion on any other brand of pills.

6. Have your child lie on a mattress during the day. Patients in a hip spica cast cannot sit up; they must lie flat. A mattress will keep the cast and your floor from getting damaged. Akira played with his toys, watched TV and interacted with his triplet brothers from a child-size mattress we put on the living room floor.

7. Take him out at least once a day. Special reclining wheelchairs are available for patients in hip spica casts. If one isn't available, lay him in a wagon padded with pillows. Both you and your child will appreciate the time outside of the home.

8. Get a special car seat, one specifically designed for hip-spica-cast patients.

9. Don't panic if your child becomes mobile. Akira began pulling himself across the floor as soon as he had developed enough upper-body strength to do so. The orthopedic surgeon told us he didn't want Akira moving around, but unless you tie him down, there's no way to prevent him. We let him scoot around the room and spin in place (an activity he loved to do to music), but drew the line at climbing the stairs and attempting to stand up. We also let him play with a fabric tunnel with his brothers.

One of the few toys Akira could enjoy with his triplet brothers was a fabric tunnel.

10. Watch that your child doesn't hurt others with his cast. Once he has healed enough and gotten used to wearing his hip spica cast, your child will start treating it like another appendage. Akira flipped his up, down and around like a mermaid with a concrete tail. We had to watch that he didn't accidentally hit his brothers or bring it down on one of our feet. Our neighbor, who volunteered to babysit one afternoon, told us Akira knocked his cast against her leg and gave her a bruise.

11. Your child may act fearful once the cast is removed. Akira cried and cried. He had grown accustomed to this heavy weight about his waist; when it was suddenly removed he was disoriented and afraid. Putting a pillow on his legs made him feel better. As your orthopedic surgeon will tell you, do not bend his legs or force him to sit up right away. When you leave the doctor's office, place your child in the reclining wheelchair as if he still had the cast on. Akira couldn't sit up or bend his legs until the next day.

To read more about our experience and Akira's recovery, see:
"Akira Broke His Leg"
"Keeping the Hip Spica Cast Clean"

For further information on hip spica casts, see:
Hip Spica Cast Patient Information (Vanderbilt Children's Hospital)
Hip Spica Cast: A Guide for Patients (Univ. of Iowa Children's Hospital)

Keeping the Hip Spica Cast Clean

2008-12-10T09:52:00.000-05:00

Note the moleskin petaling on the inside edges of the cast, which was peeling off. (The belt was supposed to keep Akira from slipping out of the wheelchair. It didn't work very well.)

If your child has broken a leg and is wearing a hip spica cast, it can be a challenge to keep it clean and dry. Our son Akira, who fractured his femur in a fall, wore a hip spica cast for seven and a half weeks. (See, "Akira Breaks His Leg.") Here are some tips on how to prevent it from getting soiled:

1. Tuck the diaper inside the cast. When the hip spica cast was first put on at the hospital, the nurses had the diaper fastened around the outside of the cast. We found this impractical and simply tucked the ends up under the cast.

2. Cut the peel-off adhesives from the diaper. These stuck to Akira's hip spica cast and the petaling and caused no end of problems. If your child doesn’t move much, the diaper should stay tucked up into the cast. If he does move around -- as Akira did -- his caretaker should check frequently to make sure the diaper is in place.

3. Check the diaper every hour. We forgot to check him once and his diaper became full of urine, which leaked and soaked the inner lining of the hip spica cast. He smelled like a public urinal for the next two days (despite the liberal application of Febreze).

4. Use moleskin “petaling” to keep the edges clean. Cast petaling -- covering the edges of a cast with waterproof tape to protect the child’s skin -- can also help prevent the hip spica cast from getting soiled. We used moleskin, a tape with a soft, almost velvety texture. It is gentle on the skin and somewhat absorbent. Once it becomes soaked with sweat or urine (or worse) -- and this will happen, no matter what you do, believe me -- simply replace it.

It’s true that moleskin doesn’t stick very well to fiberglass casts. It didn’t with Akira’s. We solved this problem by taping down the edges of the moleskin on the outside of the hip spica cast with duct tape. (Moleskin adhered with no problem to the inner lining of the cast.)

Note the blue masking tape, used to keep the moleskin petaling from peeling off.

5. Feed your child high-fiber foods. I can’t overstress the importance of this. Soft or liquid feces is much more likely to leak out of the diaper and soil the inside of the hip spica cast. This is disastrous, as it can’t be cleaned and will irritate your child’s skin. (Urine, by contrast, is sterile.) This could lead to a skin infection, or worse, so the only recourse is to remove the stained cast and put on a new one, which, with a 2 or 3 year old, means putting him under.

I made sure Akira ate high-fiber foods at every meal: strawberries or high-fiber cereal for breakfast, whole grain bread or carrots for lunch and dinner, other fruits and vegetables whenever possible. His stool was almost always solid. (But beware of grapes: too many of these and his stool will become very loose.)

6. Keep your child away from sick kids, especially those with diarrhea. If he gets diarrhea and it leaks out of the diaper and down his legs, the hip spica cast will have to be removed and a new one put one.

7. Take special care when bathing your child. We were advised to bathe Akira every day. This is necessary because children sweat a lot wearing a hip spica cast. To keep his cast dry during the bath, we laid Akira on a plastic sheet placed on a bed and wiped him down with a damp washcloth.

To wash his hair -- which we also did every day -- we had him lie on his back and hang his head over the side of the bed (the plastic sheet hung over the side of the bed too, under him). We then shampooed and rinsed his hair over a plastic storage container -- one of those for clothes which you can find at Wal-Mart or Target.

Further reading:

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