Broken femur - Spica cast

[SP8]

My 6 year old daughter broke her femur after a horse riding accident almost 3 weeks ago. She suffered a mid shaft spiral fracture. She spent 6 days in hospital we seen three different surgeons whilst in hospital, two who wanted to operate and believed a cast would not work and it would end in operation if we tried the cast. The third surgeon who ended up being the one to take her to theatre decided it was worth the risk of trying the cast. A week after having the cast applied she went for an x-ray check up seeing a different consultant who wasn’t happy with how the fracture was healing and also didn’t understand why it wasn’t operated on in the first place, it had started to come out at an angle and the fracture was quite wide apart. They cut the cast open and inserted a wedge and cast back round it, they xray’d again after and it looked slightly better. He did say they would check again a week later and if there was little to no improvement they would have to do the operation. Today she went back again and the fracture was more apart than the x-ray the week before, but seen a different consultant again! He said he didn’t see a problem with the bone being apart and that children heal great. I expressed my concerns and told him what the others had said but he was adamant there was no need for an operation. Due to it being a spiral fracture from the front it doesn’t look to bad but from the side it just looked awful in my opinion but i’m no expert and trying to have trust in the people who are.
Im curious to see if there is anyone out there who has had/child has had a fractured femur and the x-ray’s looked to not be improving and by a miracle have healed completely fine?! It’s been a very stressful time and I’m worried she could spend 6 weeks in this spica cast and still need an operation at the end.
Thanks if you got this far!

Unsure if this will help since I'm a 58 year old woman not a child. I suffered a mid shaft spiral fracture of my humerus (it wasn't funny it was blooming painful!) and spent 7 months trying various treatments to no avail. I ended up with surgery and went home the same day so much better! I would push for surgery

@Crispynoodle oh no! i’m sorry to hear that and hope your doing better now? I told the latest consultant that i really did feel operating would be best at this point and that i don’t want to be here in 6 months time because she’s having pain or walking with a limp, he made me feel terrible for wanting an operation and reeled off all the risks. Really hoping we see one of the other consultants at the next appointment if not will push for a second opinion

I would contact PALS and express your concern that your daughter has seen so many consultants and they all have differing opinions meaning she isn’t receiving consistency of care and is likely delaying the potentially inevitable surgery.

By week 3 into treatment, there really should be some improvement and the fact the fracture has widened despite the wedge and spika cast would be my second concern. As a PP says, I’d be pushing for surgery as it looks like it’s going to be needed eventually anyway and, until it’s done, there are likely to be issues with accessing schooling and general activities for a 6 year old.

were you at a specialist children’s hospital? We were lucky to live near one and ambulance took us there.

my DD broke her femur aged 5 and we were given the options in ED on the day of the accident for surgery with rods inside bone or cast.

the doctor recommend surgery due to the practicalities of managing a cast on an older child. Apparently under 4yrs the middle of the bone is too narrow for surgery, so they have to cast.

hers was totally broken mid shaft and the bones overlapped.
had the op the following day and made a good recovery.

@LovedFedAndNoonesDead Good idea, I will give them a call today. Exactly our worry that it could be a super long recovery with no good outcome

@Doglover357 Yes we were at a specialist children’s hospital, the major trauma centre for the south west. We were told in A&E the cast would not work and surgery the only option, again once on the ward by a different doctor then third doctor decided to cast it’s been so frustrating. The two first doctors actually told us they don’t tend to cast on children over 5 , and she would make a better recovery with the op and the cast would unlikely work. We expressed all these to the third doctor but he still went ahead with the cast. I will phone pals today like the person above suggested. I’m glad your daughter made a good recovery

Just thought it was worth me noting that we actually signed all the consent forms for the nails and rods operation, and it was explained just before she went down they were going to try the spica. So it was at the last minute i was informed of the spica.

I'd also push for the surgery. A friends daughter had a similar injury, also age 6 and had surgery a couple of days later. She made a full recovery.

Hope you get it resolved.

We are also in the Southwest so I can only think of 2 possible hospitals you’re under - one has a PICU the other has an HDU and are about 75-100 miles apart.

@LovedFedAndNoonesDead I’m sure the one we are under has both.. bristol children’s?

That was the PICU hospital - the other is Derriford in Plymouth.

Hi, how is your daughter now? Did she end up having surgery or cast?
My 2 years old broke a femur and was in traction for a week, then had a surgery to put him into the spica cast for 3 weeks and he is wearing the big cast now.

Hi @Violina shes doing brilliant and you would have never known that she broke it. She didn’t end up having surgery but right up until two weeks before the cast came off there was talks of surgery as it didn’t look to be healing as well as hoped. So when we went and they were happy to take it off it was a huge surprise. She’s signed off from physio and back riding :) good luck to your little one, they bounce back so quickly!

Thank you @SP8 for the reply and I’m so happy that your little one is absolutely fine 😍
The doctors also suggested a surgery but after being in traction, he had a “surgery” to put him in the cast, so fortunately nothing invasive.
We are going there next week for the cast removal and then he won’t be allow to walk for another 2 weeks (I can’t imagine but at least he won’t be that heavy).

@SP8 Also how long your daughter wore the cast? We have just found out that he has to stay in the cast 1 week longer because the clinician works only once a week and he won’t be there when my child supposed to have his cast removed. 😣

@Violina She had it on for 7weeks, ah that’s a shame but i’m sure a week will fly by :)

Just found out yesterday that he has to stay another 2 weeks with the cast as X-ray showed that the bone didn’t heal properly. How did you survive 7 weeks? I’m so disappointed 😔

@Violina Oh no sorry to hear that! Definitely better to be in it a bit longer and everything be fully healed than chance it too soon. Board games, tv, ipad, books, magazines. We bought a little sports set which you had to throw hoops onto cones and little balls, nintendo switch just things like that. We also hired a wheelchair and tried to get out everyday that was the biggest help for us

@SP8 Thank you. Best wishes!