Q: Our son is being evaluated in the ER for a broken leg -- snapped the middle of the thigh bone in two. He's in kindergarten half-days. Will this keep him from going to school? We both work and don't have time off for an extended period of time. I'm pretty worried about how we are going to manage.
A: Young children with a fractured femur (thigh bone) can be treated in a number of different ways. Most involve casting of some sort. To prevent movement and allow the bone to heal, a spica cast is used most often. This type of cast starts at the waist and goes all the way down to the toes.
The spica cast may be single leg or double-leg. The single leg cast ends above the hip on the uninjured side. This type of cast leaves the uninjured leg free to move. The double leg cast immobilizes the injured leg from waist to toes and covers the other hip down to just above the knee. Not being able to bend at the hips (and knee) for four to six weeks presents some difficulties for families caring for young children.
Treatment of femoral fractures like the kind you described is with spica casting. This is considered "best practice" based on recommendations from the American Academy of Orthopaedic Surgeons (AAOS). Cast immobilization avoids surgery with anesthesia, scarring, and the possibility of complications.
Surgeons recognize that casting has its downsides. Caring for a child in such a bulky cast is no easy task. Transporting the child in the car seat or car, toileting, and lifting and carrying the child are some of the challenges the family members or caretakers face.
But the good news is that a single-leg spica cast is possible for some children with this type of injury. They must not have more than a 25 mm shortening of the bone or surgery to pin or plate the bone. A recent study from The Johns Hopkins Hospital in Baltimore, Maryland reported on the benefits of a single-leg spica cast. They said their patients' parents and care givers reported taking fewer days off from work to care for the child.
The single leg cast could also be molded with enough hip and knee flexion (bend) to allow the child to sit in a special car seat. And the children with single-leg spica casts could sit in chairs more comfortably. Children in this type of cast could even walk a little bit. Attendance at school should be possible but your surgeon will advise you according to what your child needs. You may want to let the school know of any special needs your child will have during this time of immobility.
Reference: Dirk Leu, MD, et al. Spica Casting for Pediatric Femoral Fractures. In The Journal of Bone and Joint Surgery. July 18, 2012. Vol. 94A. No. 14. Pp. 1259-1264.
