Houston Methodist. Leading Medicine

Ankle FAQ

Question:

I'm searching the Internet for any help I can find. Our six-year-old daughter broke her femur in a car accident. She was safely in her booster seat in the backseat, but the force of the impact caused her seat to get shoved up under the passenger seat in front of her. Then the passenger seat got lodged against her leg. They have put her in a full spica cast. My problem is I also have a younger child with cerebral palsy who had a hip derotational surgery two weeks ago and she is also in a hip spica. I simply can't handle both. Can the cast be taken off the six-year-old and some other splint be used instead?

Answer:

This is definitely a question for your surgeon. Given the circumstances, if there is any way around it, the surgeon will no doubt try to find a creative solution to the problem. Some of this decision depends on the type of fracture, especially severity. If the fractured ends of the bone have separated, casting is important to avoid further displacing the bones and ending up with a significant difference in leg length from one side to the other. Your child's weight also helps determine what can be done. If she weighs less than 90 to 100 pounds, it may be possible to place a long pin called an intramedullary nail down the shaft (center) of the bone. This is one form of fixation used to hold the bone together while it heals. The location of the fracture is also a factor. This technique isn't always possible if the break is at the top or bottom of the femur (rather than in the middle). Femoral fractures in children is an area where the research is lacking. More and better research is needed in this area. Although there has been a trend toward surgical care instead of traction and prolonged casting, high-quality studies comparing the two approaches have not been done. Ernest L. Sink, MD. AAOS Releases First Pediatric Clinical Practice Guidelines. In AAOS Now. August 2009. Vol. No. 8. Pp. 1, 12-13.

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