After care for a spiral femur fracture in a child

Hello,
My 2 year old daughter suffered a spiral fracture of the femur 5 weeks ago after a fall from a bunk bed. She spent 5 days in gallows traction before being placed in a hip spica. She is due to have the cast removed this thursday. I can clearly see that she has suffered muscle wastage across her whole lower body.
We have had no mention of physio requirements for her after the cast is removed just a general 'You'll get on with it attitude'
On an unrelated matter my wife attended her local GP and in conversation the situation was spoken about. He stated that the NHS would not mention it as they would not want to fund any physio treatment and we should try to look at going private.
My concern is will the NHS just allow us to walk away on Thursday with no referal to a physio when it will clearly be needed or is the requiement for physio in a child so young not required.
I do not want to misunderstand the situation and cause future problems for my daughter.
Any advise would be gratefully recieved as i have hunted the net for info on post care to no avail.

Certainly when I worked in the NHS we saw children in out patients after this type of injury, whether we saw them all or just those who were problematic i am not sure. I know from collegues that cut backs are effecting services.

Definitely ask about it when you get the cast off. Even just getting some advice is useful. Children do generally just get on with it...however knowing what to watch out for is useful. Even if you have to see a physio privately (who deals with children) for advice it is probably worth it (do check out whether they are registered with OCPPP (private physio organisation) this site will give you an idea of their specialities, also ask about experience levels etc. Generally if a physio is registered with BUPA for example they will need to be at least 5 years qualified.

Having a 3 year old and 5/12 old I know how much mischeif they can get into and how you ant to do your best by them. If you are doing activities with your child to help mobilise / strengthen make sure that they are fun, varied and for short periods only.

Good luck and do ask about seeing a physio.

Hi there, sorry to hear about your daughter and her spiral fracture and subsequent casting. I know from experience what hard work spica casts are.

I am a physiotherapist, my main experience is in adult neurological rehab (head injuries, stroke etc). However my daughter was diagnosed with hip problems as a baby (developmental hip dysplasia) so has had two ops with 6 months of hip spica as a baby, and more recently (August 2007) as she required surgery with 6 weeks of casting. So I have personal experience, that I hope can help you and reassure you.

Following her last lot of treatment and casting, my daughter had a lot of muscle wasting. She lost 1 and half kilos. The physios also did not routinely see her case, and I could not even get a small walking frame for her. However with support from me she was walking within about 5 days of coming out of surgery and was able to stand independently shortly after. Children do progress along at their own rate.

I was a bit niggled that she did not have physio follow up, but to be perfectly honest (and its hard for to say this) they were completely right. She didn't need input.

Her surgeon suggested lots of swimming, and cycling is good for them if she is able to pedal yet because of the type of exercise (closed chain).

Now 6 months on, you can still see some balance problems and she has a swaying gait (lateral sway with anterior pelvic tilt) when she walks particularly when tired (more to do with her surgery I think - I am not sure you will see this in your daughters case) . She is just starting to swim for herself with reduction in buoyancy aids. She can hop, jump, run but her walking distances remains limited, as she tires. She does ballet and tap on the weekend, which I think is helping to improve her balance. She's always improving.

I go along with what physio bob suggested. I think it would be nice for someone to have a look and reassure you, if anything and maybe give you some advice. However if paying for a private physio is out of reach, be reassured that she will "get on with it". I would think she is too young to do formal exercises with - best to be inventive and give her opportunity to do kid stuff.

You should be followed up by Dr at fracture clinic so if you do have concerns you can express them there, or failing that your GP. I always find that when I have been really worried the physios down at child development clinic will also take my call.

Hope thats been useful.

Hi,

I too agree with the above. I see a lot of little 'uns in my private practice although not one with a sprial fracture of the femur before!

Having said that, children are REALLY resilient. It is hard to keep them down. And because they don't know any differently, they will get on with things as they are able to.

Also, i have 3 kids, my youngest a 2 year old. It is DAMNED HARD to get him to do ANYTHING he doesn't want to - what i am trying to say is that the suggestion above about playing with your child is a good one. Trying to impose physio exercises etc would be difficult but a good physio would be able to show you how to use play as therapy.

For my "broken arms/legs", i actually just show them some simple exercises for the few days that your child will be hesitant and likely to be compliant. But i just offer to call them in 2 weeks to make sure they are back to normal. I can honestly say that i haven't had a complication in that time - by the time i call, the parent says something along the lines of "oh, yeah, they're back to normal - i forgot you were going to call!".

Believe me, you will know within a week or two if your child is not going right! If in doubt - just ask your doctor.

Good luck!