More Than I Ever Wanted to Know About a Toddler with a Broken Femur and a Spica Cast

<<< If you found this via Google search because you are in a waiting room while your toddler’s broken femur is being set and a spica cast is being put on, please skip my wordiness and just scroll down to the big heading in the middle of the post or – even further – to the Q&As if you want. Also, you’ve got this! You’re a good mom, and your kid is going to be as good as new in no time! >>>

Friday will be two months since we took Nora to the ER thinking she had *maybe* sprained her leg and left in a “body cast.”  That Sunday afternoon, I felt a million emotions – shock, guilt, worry, fear, dread, frustration, sadness – and, I honestly had NO idea how we’d survive this unexpected curve ball life had thrown. But, now, here we are…

Spoiler alert: We did it!  Nora has been cast free for four weeks now and, looking at her, you’d never even know she had a broken femur. God, little bones, and modern medicine really are amazing!

I’ve obviously waited a while to share all the details; but, honestly, I just wanted to have it (mostly) behind me. As you can imagine, much of the time Nora was in the cast was spent in “survival mode,” and even after it came off, I needed time to process, breathe a little, and catch up in all the other areas of my life. I truly felt like this whole experience just kind-of happened, and Jeff and I just went through the motions doing the next thing. Now that we are on the other side, I can see how fortunate we have been, I can reflect/comment on all that we’ve experienced, and – hopefully – I can be helpful to someone else in a similar situation down the road.

With that in mind, here are three reasons I’m writing this post:

1.) You guys have been so supportive and encouraging here, on Instagram, etc. and many of you have asked questions. I figured you at least deserve to know what happened and what’s next if you want to.

2.) In the moments after we found out Nora had broken her femur and was going to be in a spica cast (mostly while we were sitting in the waiting room helplessly during surgery), Jeff and I were on our phones scouring Google for any and everything we could find. He, of course, preferred medical reports, studies, etc.; but, I REALLY wanted “mom experience” type things. I needed to know how this was going to affect our lives, how logistical things like diaper changes and carseats were going to work out, and that my girl was going to walk and be “normal” when it was all said and done. I intentionally gave this blog post a very wordy and not very creative title in hopes that it will one day be among the many that come up when another desperate parent Googles “toddler broken femur and spica cast.” If our experience can be helpful for anyone else, I want it to be. ALSO – and this is important – a lot of what we came across was super scary and negative, and our experience – honestly, all things considered – was pretty much the best case scenario. I REALLY hope my story will not just be helpful, but also encouraging to another momma.

And, finally…

3.) One day I will forget these details. Mostly, that’s a good thing, but it is a story Nora will likely want to hear when she is older, and I want to write it down for her. Also, I’m super proud of all of us (mainly Nora, of course, but her recovery was totally a team effort), and I want to remember this small (in the grand scheme of things) storm we weathered together.

There are also a couple of little disclaimers I need to get out of the way:

– This probably goes without saying, but just to be clear: I’m NOT a medical expert. If you think there’s a chance your child might have a broken femur, you need to go to the hospital. (Take it from me! You’ll feel terrible if you wait too long!) This is simply our experience and the few things I learned about bones/bodies along the way… If anything you read here contradicts something your doctors have told you, without question, believe them.  😉

– Of course a broken femur and a toddler in a huge cast IS a big deal, and it felt like a REALLY big deal; but, I do recognize that it barely even touches some of the health and other struggles families have to deal with all the time. While this did affect our lives quite a bit for a short time, this post is, in NO WAY, trying to say that what we experienced here was a “worst case scenario.” If anything, it had the exact opposite effect by reminding me, again, how much I truly have to be grateful for.

– And last but definitely not least, please know that we did NOT survive this without the help of an incredible village! From the minute we realized what we were dealing with, we had SO much help and support from the people closest to us!!! My mom actually happened to be in town when everything happened (she’d come in for Nora’s birthday party) and ended up staying for two full weeks to help us adjust, entertain Sam, etc.  She did lots of practical things, but it also helped SO much just having my mom with me as I navigated the early days of everything. Jeff’s mom, too, jumped right in and learned all the ins and outs of cast life quickly – she even went out and bought so many “stationary” toys that Jeff’s dad asked her if she thought Nora would be in the cast forever. Lol. Both my work and Jeff’s were incredibly patient and flexible, and our regular sitter was AMAZING – she came to the hospital and was involved in every single step of recovery without ever missing a beat. Beyond that, we had friends provide meals, stop by with sticker books for Nora, offer to keep Sam, etc. I will forever be grateful for all the ways people jumped in and took care of us when we needed it, and I can’t imagine doing it alone.

Whew, ok. Here we go…  The story you’ve all been waiting for… 😉

(My apologies in advance for my lack of brevity, though I know you’d expect nothing less…)

That time when Nora broke her femur and had to wear a “body cast” for five weeks:

What happened?

On Saturday, March 25th, we had Nora’s second birthday party at a cute little cupcake shop in a nearby neighborhood. The weather cooperated with us, and it was a beautiful day. After a yummy brunch and too much sugar with friends, we weren’t quite ready for the fun to end; so, we cleaned up from the party and headed to an elementary school playground down the road a bit with our best friends and their little boy. I was slightly worried that this was a bad idea since it was nearing naptime and Nora had been going hard all morning, but she was totally in “party mode,” and I figured it wouldn’t hurt anything to push her nap back an hour or so… At the park, while we watched the kids playing, I actually commented to my girlfriend how “wild” and “tough” Nora is. (Bless my little heart.)

Now, I hate to disappoint here, but there is no dramatic fall story. In fact, the whole thing was the opposite of dramatic… There was no ambulance or panic. Instead, one minute I was watching Nora play on a stand-up teeter-totter – still wearing the flamingo rash-guard she’d just gotten as a birthday present over her party dress and her face stained red from strawberry cupcakes – and the next, Jeff was scooping her up off the ground. She fell *maybe* two feet.

I didn’t even get up from my seat. It was no.big.deal. I figured she’d be playing again in a minute; and, when she didn’t seem to be able to pull it together and recover, I wrote it off as her being overtired, said our goodbyes, and loaded her in the van to head home… As I was buckling her in, she did complained that her leg hurt; but, honestly, I brushed it off. She’d been fighting the rear-facing carseat lately, and I assumed she just didn’t want to be buckled. (That was the only time she even mentioned her leg the rest of the day.) I gave her her pacifier and secretly planned to go through Starbucks drive-thru for an iced coffee when she inevitably fell asleep in a few minutes.  When she didn’t, I thought it was odd; but, again, no big deal. I skipped Starbucks since she was still crying, took her straight home, changed her diaper and put long pants on her, and put her to bed.

Not surprisingly in hindsight, naptime was unsuccessful. Obviously exhausted by this point, she kept falling asleep and then waking herself up and crying out. Of course now I know that that’s because she was in terrible pain, but that  never even crossed my mind that afternoon. At the time, I barely even remembered that she had fallen. Again, I chalked up her bad nap to being overtired and having too much sugar, and I spent the next two hours rocking her and trying to get her to calm down. I Googled “why is my toddler startling awake?” and took her temperature to check for a fever, but she didn’t have one, so I never even gave her Tylenol.

After awhile, my mom radar (finally) started kicking in, and I told Jeff something was wrong… Not only would she not calm down and go to sleep, but I also noticed that she wouldn’t let me put her down. When I would try to, she’d grip my shoulders hard like she was afraid. I was beginning to be a little worried, but a broken bone wasn’t even on my list of possible problems.

We had plans to go out to dinner with my family that night, so around 4:00, I texted my parents and sister telling them what was going on. I told them to come over and we’d see how Nora did with some “distraction,” so they did. She cheered up a bit around everyone, but it was my sister who actually first noticed that she seemed to cry when we tried to touch or move her. It was almost 5:00 (more than four hours since she’d fallen on the playground) before I took off her little leggings and noticed that her left leg was swollen. That was also when I first realized that she hadn’t had her feet on the ground since the fall.

This part may sound crazy to you if you’ve never been in this situation, but even after seeing the swelling and realizing she wasn’t walking, I still didn’t think anything was seriously wrong with her leg. Yes, she’d been fussy, but – I don’t really know how to explain it – she wasn’t out of her mind. It just wasn’t what you imagine when you think of breaking a bone – especially the largest bone in your body. All the adults agreed that we should just give her some medicine and see how she did. We thought maybe she’d twisted her knee or “bruised the bone” or something.

Anyway, after I (finally) gave the poor girl some Motrin and an ice pack, she seemed OK. She still wasn’t walking, but we ended up going to dinner that night anyway, and she sat happily at the table, ate a grilled cheese sandwich, and went to bed with relative ease that night.

Late that night, I started Googling “toddler leg injuries” and decided – only then – that it was *possible* she had a minor break. I texted two friends that are Pediatric Physician’s Assistants and got conflicting advice from them, and I knew Nora really needed to sleep; so, I decided to wait until morning and take her to in then if the swelling still looked bad.

She slept all night that night – WITH A BROKEN FEMUR – but woke up pretty mad around 6AM. By that point – though the swelling wasn’t any worse and there was no obvious bruising or anything like that – I decided we’d waited long enough. Besides, it was my birthday, and we had brunch reservations for later that morning, so I figured we may as well get her to the doctor just to rule out something serious…

My sister came over to watch Sam, and Jeff and I headed to the ER around 8AM. At this point, I’ve got to tell you, I was feeling pretty silly. *I always overreact.* *The ER docs are probably going to laugh at me.* *I wonder how much an x-ray to tell me she’s fine is going to cost.* In fairness, Nora was grouchy; but, again, not hysterical. I figured in the very worst case scenario she’d have a small fracture, they’d wrap her leg, and we’d see an orthopedic doc on Monday morning. I assumed we’d be home by 10.

This was my first ER experience with either of my kids, and I was shocked at the quality of care we received there. Maybe we just got lucky, but they took us back to triage immediately (like, we never sat down), and we were in a room watching Frozen within 15 minutes of arrival. The doctor that came to check on us said she suspected a “toddler fracture” which – as I’d learned from Dr. Google the night before – is relatively common/mild and ordered an x-ray.

Apparently x-ray technology has improved quite a bit since I broke my hand back in 1998, because the techs just rolled in a little cart and stuck a board under Nora’s leg while she sat on my lap. Since I was sitting with Nora, I couldn’t see anything on the x-ray screen, but I didn’t need to because Jeff could, and his audible gasp when the image of her leg appeared was enough to tell me we weren’t going to make it to brunch…

To fast forward a bit, the ER doctor came back in and opened with… “Well, it’s worse than we thought.” It turns out, Nora had a pretty severe spiral fracture of her femur — the largest and strongest bone in the body. I’m telling you, this girl goes big or goes home. 😉  Due to the type of break she had, we now suspect that it actually occurred in the process of the fall – basically, her left foot stayed planted on the tire while the rest of her body rotated and fell off – not in the fall itself. (FYI: I don’t think this particular type of teeter-totter is very common, but here’s the best picture I can find of one in case you need a visual.)

At this point, I was pretty much feeling like the worst mom ever — how could we not have known this immediately?!?! My poor girl must have been in SO much pain over the last 24 hours!!! I was already in tears as the doctor told us to “make arrangements”  at home and work because Nora would be having surgery that afternoon, staying at least a night in the hospital, and wearing a cast covering both legs and most of her body for approximately 12 weeks. To say I was overwhelmed and heartbroken would be an understatement; but, right at that moment, my sweet, tough girl – totally calmly – turned to me and said “No, Momma. No sad. No cry” as she wiped my tears. I, eventually, pulled it together for her.

*Side note: I had NO idea at the time, but I’ve done a little research on femur breaks in toddlers, and it turns out that these are actually one of the most common child-abuse injuries. It absolutely KILLS me to imagine how someone could hurt their child this way; but, I’m incredibly grateful for the way the doctors and nurses treated us with kindness and never made us feel bad as parents. They did their due-diligence (as they should) by asking us a million questions and even checking to see if we had any “accident witnesses,” but Jeff and I were never made to feel blame or shame.

As it turns out, once we finally met with the pediatric orthopedic surgeon – there’s only one in our city and she happened to be in the hospital that afternoon – she said she thought she’d be able to fix Nora’s leg by only having to cast ONE leg instead of both (a HUGE blessing as this makes basic things like carseats MUCH more manageable) and predicted she’d be in it for 4 -6 weeks (instead of the 12 they had originally suggested). She also said we likely wouldn’t need to stay overnight.

She patiently answered all our questions, let us pick out a color for the cast (purple seemed “girly enough” without being overkill and would maybe hide some dirt/food/etc.), and wheeled our girl back to the operating room for what is called a closed reduction surgery. (It’s called “surgery,” but, really, it’s non-invasive. The anesthesiologist simply put her to sleep so that the orthopedic doctor could set her bone back in place while looking at it via x-ray and then create a very “fancy” cast from her armpits, around her waist, and down to the ankle of her left leg.)

Jeff and I were away from Nora for less than hour but, naturally, it felt like forever, and we both teared up with relief when we finally got to see her. Even though she looked TINY laying in the big hospital bed, and about 75% of her body was covered in purple, she was safe, and things had gone well. The surgeon even wrapped her little doll’s leg in an identical purple cast for her – precious.

Around 3:00 that afternoon – a Sunday and my 33rd birthday – we were released from the hospital and sent home. We had no idea what we were doing. Hospital policy requires you to leave in a wheel chair when you are discharged from surgery, but since Nora couldn’t sit, I had to hold her (baby-style) in my lap and be pushed to the car. As Jeff met us at the end of the walkway with the minivan, he reminded me that it was EXACTLY two years (almost to the minute) since I’d been wheeled out with newborn Nora to bring her home for the first time. Man has this girl ever us a WILD RIDE!  😉

And, there you have it. Day 1 of this adventure. It feels like SO long ago and only yesterday.

Now, some answers to your FAQs:

Could she sit in a chair? Be carried? What did you do about a carseat? High chair? 

The simple answer to these questions is that she could sit in some chairs. We were, again, extremely lucky that Nora’s cast only covered one leg completely. This made sitting much easier, but still not exactly *easy*. Since the cast went around her waist and up to her armpits, she could not bend at the waist. Therefore, chairs needed to be very reclined. Thankfully, we could buckle Nora into her normal Britax Marathon carseat once we flipped it forward-facing (ironic since the day before all this my biggest “parenting stress” was deciding whether or not I should turn her seat around) because it leaned bag; but she did NOT fit in the Graco Nautilus carseat we had in Jeff and our sitter’s cars. (From what I understand, kids that have the spica on both legs have to have custom carseats made that allow the child to lay down on the seat.)

It was difficult for her to sit in anything too hard – basically, she would just slide down/fall out of the chair – so must normal chairs and high chairs were out. For five weeks, she ate almost every meal on my lap (or someone else’s). I could hold her pretty comfortably (for her) on my hip once I got over my nerves about it and got used to it, but she was SUPER heavy and awkward.

At home, she sat in a big over-stuffed chair with lots of pillows or in a beanbag – we borrowed a beanbag after several people on the internet recommended it, and it was a LIFESAVER! These worked well with a TV tray over it (we’d gotten two as a wedding gift ten years ago and used maybe twice,so it was fun for Sam to have one too) for snacks, coloring, games, etc.

We also found that the fabric of an umbrella stroller (or one of those folding chairs like you take camping or to a sports game) was perfect. In addition to being used on walks etc., it was just the right size to pull up to a small table etc.

And, finally, Nora just spent a lot of time laying on her belly on the floor. After the first week or so, she could hold the front part of her body up for a while to play with toys when she was like this, and by week three she was scooting herself pretty much wherever she wanted to go. To be honest, I wouldn’t have thought to put her on her stomach because it just looked so darn uncomfortable, but a friend that had been through this suggested it, and Nora really liked the little bit of freedom it gave her.

What could she wear with the cast?

The spica cast is BIG and bulky, so dressing was not particularly easy, but it was do-able. Honestly, dresses or just wearing a diaper only on the bottom was the best, but it was cool about half the time she was in the cast, so we also bought several pairs of sweatpants / “cozy pants” with an elastic waist from Walmart in two sizes too big and those worked well. She mostly wore her normal tops, and I just tucked them in to her cast instead of stretching them out by pulling them over. Her feet were free, so she wore normal shoes and socks – more for style and warmth since she wasn’t exactly using them. 🙂

What about changing diapers?

I never got a good picture of this, but the butt of the cast was actually open so that we could use diapers. We changed diapers pretty much as normal EXCEPT we used two – one went on the bottom and got tucked in to the cast itself, and a second one (in a size bigger than she normally wears) went over the whole thing including the cast and fastened. The nurses showed us how to do this before we left the hospital, and it felt pretty overwhelming, but I got the hang of it quickly, and it was fine. We were also VERY fortunate not to have any real accidents – but I read lots of horror stories about that on the internet!!

Baths?

The cast could not get wet, so we did sponge baths only for the entire time she was in it. Typically, I wrapped the bottom half of her body in a towel and tucked it in to the cast to keep it dry, then laid her on another towel (usually folded to be more comfortable) on the kitchen counter with her head hanging over the sink. I could wash her hair that way and used a wet rag with soap on the rest of her body. I’ll be honest though, she hated this, and it never really got easier.

Did I work? What about childcare?

In the very beginning, I did consider taking FMLA and staying home for the duration of Nora’s healing; but, in the end, our regular sitter was willing to take on the challenge and I knew Nora would be in VERY good hands with her. This was another one of those things that just reminded me how very blessed we are — I don’t know what we would have done if Nora had been in a normal daycare setting, I can’t imagine that they would have been able to accommodate her. Jennifer was AMAZING and never missed a beat.

How were nights? Did she sleep?

Not really. We, of course, had good nights and bad nights. Mostly she hated her bed and she woke up several times at night and wasn’t able to get comfortable or put herself back to sleep. I also think she got hot at night – temperature control can be a real problem with these things – which didn’t help.

Some times I put her in bed with Jeff and me, but she took up a lot of space. So, honestly, most nights she slept on the beanbag, and I slept right next to her on the sofa.

It was less than fun, and the rough nights did make getting up and going to work hard, but we survived.

(On a semi-related note: I just noticed this week that the sheet that was on her crib most of the time she was in the cast – which is muslin by Aden + Anais – is all torn up from the cast rubbing on it!)

How did she handle it? What did she do for five weeks without being able to sit or move?

Really, she did SO well. I admit that we spoiled her — she had a lot of snacks/sweets and a lot of screen time during those five weeks — and she did develop a bit of “diva syndrome,” but I was really so proud of her. For someone so little, she really seemed to understand what was going on and just calmly accepted it when I told her she couldn’t do something – like jump in the bounce house at our neighbor’s birthday party – because of her boo boo.

In addition to cartoons and movies, we liked reading books, coloring, putting stickers on everything, working puzzles, building with blocks/legos, and playing with small toys like Little People figurines and plastic animals. We had to avoid rainy or super hot days, but we also tried to get outside when we could for walks, wagon rides, a swing, etc.

While, in the beginning, we adapted our daily routine quite a bit and stayed home most of the time, by the end we were doing life pretty much as usual. I was even able to take the kids on a three-hour road trip for a few days over Spring Break to visit a friend, and Nora did great!

Of course, there were bad days. She got frustrated and acted up at times – like any toddler – and discipline was HARD. Jeff and I tried to walk a very fine line between not letting her get away with anything she wanted and also recognizing that we’d probably be pretty grouchy too if we were wearing the get-up she’d been trapped in for weeks. Thankfully, she really did seem to bounce back to her normal self (and our normal rules) once the cast was off – the iPad detox period wasn’t even too bad. 😉

(I also decided NOT to get rid of her pacifier, as I’d originally planned to, after her second birthday, and that – I think – brought her a lot comfort.)

How was Sam through all of this?

Amazing. He thought her cast was so cool, and he even got to take her x-ray to school for show and tell during “x” week. 🙂 I don’t know why I was surprised, but he was incredibly patient and helpful. This meant some sacrifices for him too, for sure – small things like not going to the playground in the afternoon because Nora got too upset just having to sit in her stroller, and big things like missing out on the beach trip we’d planned for spring break because giant casts + sand, water, and hot weather are not ideal – but he didn’t complain once. This was just further proof that he really is the best big brother ever.

And finally, some “fun facts” and details about recovery…

– Probably the most interesting thing we learned in this process is just how amazing the human body is – especially super little bodies. In an adult, this kind of break would have a.) been absolutely unbearably painful and b.) taken 3-6 MONTHS to heal in a cast followed by rehab and physical therapy. Nora, on the other hand, at just barely two, wore her cast for not quite 5 WEEKS and was walking within days of having it removed. We have had no physical therapy at all, and she’s now walking without so much as a limp. In fact, just the other day I found myself hurrying her along and getting frustrated that she was walking too slowly… My how quickly we forget!

– Another pretty fascinating detail about little bones is that they often heal SO well that they actually grow TOO much because of the all blood pumping to the location of the break. To counter-act this overgrowth, Nora’s doctor actually set her leg slightly shorter than the other one — the bones overlap by about 2 centimeters. I showed a photo of her final x-ray to an EMT friend of mine (who isn’t experienced with pediatrics) and he thought it was before it had been set. Nope. The bones have grown back together and a tough callus (that you can actually feel under her skin if you try) has formed. Her left leg will be – unnoticeably – shorter for the next two to three years; but, as Nora grows, it will all even out. No problem. (Fingers crossed. I admit that this part of it is pretty nerve-wracking for me, but I’m trusting the process.)

– Taking the cast off was a little traumatic. They cut it off with a saw, which was scary for Nora and – oddly – she’d grown pretty attached to her “purple leg” as we called it. In fact, during the whole removal process, she was screaming and begging them not to take it off!! #weird Once it was off, the leg was very very stiff from being immobile for five weeks, but Nora’s first reaction – in her frustration – was to kick, which hurt. Truthfully, she cried more in the office when they took her cast off than she did the day they put it on. We were, obviously, thrilled to have that thing gone forever, but the first couple of days of life after the cast were hard. She was sore, it was hard to see her unable to walk still (though the doctor had warned us it would take a while), and Jeff and I were nervous. *Also, in case you’re wondering, she stayed surprisingly un-smelly and clean in her cast, which I felt pretty proud of. I think it helped that it wasn’t super tight, and it wasn’t super hot yet, but still…

– The orthopedic doc gave us a rhino brace for her to wear after the cast. She assured us that it was for COMFORT ONLY – meaning, she didn’t *need* to wear it, but could if she was hurting and wanted extra support – but that some kids needed it for up to six weeks. Nora wore hers home from the doctor and never again. (We’re the proud owners of it though, so if you ever need one…) By the second day, she was walking with help – holding on to something/someone or pushing something like a cart, by day three she was taking a couple of steps by herself, and by one-week post cast she was walking – with a limp. The limp went away gradually, and I can’t remember exactly when, but now – at 4 weeks since the cast came off – she walks, runs, jumps, etc. like a “normal” two year old. Amazing, I’m telling you! (We go back for our first follow up appointment on June 12th with an x-ray, so we’ll know more specifics about how her healing is going then.  But, I’m anticipating a good report.)

– While she’s mostly her normal self, I do thinks she’s a little more fearful these days than she was before the break. While she will climb all over a playground, she hasn’t braved going down the slide by herself yet, and she gets scared when she’s up high/there is potential to fall (like if I sit her on the kitchen counter for a second). This is unlike her, but not necessarily a terrible thing; and something that will likely fade with time. As for me… This whole experience, on the one hand, has made me more fearful and nervous. I’m typically pretty laid back when it comes to letting kids play and take risks, but this made me accept that accidents DO happen and my kids are not immune. I’m also terribly nervous about her re-injuring that leg, so I’ll stop any kind of play that looks to rough and we won’t be going near a trampoline (or a teeter-totter) for quite some time. At the same time though, this reminded me that our bodies are strong and we are resilient – both physically and emotionally. I’m not naive enough to think that we will never have another accident/injury, and I’ll feel better prepared to handle it when that time comes.

SO, there you go.

Time and time again, parenthood has taught me that I am capable of MUCH, much more than I think, and this was definitely proof of that. Also: I believe in the VILLAGE now more than ever before.  I’m so grateful for my team in this game.

I know this post is LONG, and I’m sure most of my regular readers didn’t make it through it all. But, one more time, if you are a parent in the beginning of your own spica adventure, I hope you’re taking away a message that – though not exactly fun – this is DO-ABLE, and it WILL BE OVER before you know it. Hang in there!

If there are any questions I missed etc., leave them in the comments, and I’ll try to respond there. THANK YOU, again, for loving our family through this experience and praying for my girl!

E