After the External Fixator is Removed – What’s Next?
Any time my child goes in for surgery it’s rough. I dread the day as it approaches. It’s gut wrenching to watch him get prepped and wheeled off by staff to be cut open. However, I felt differently about this time.
I couldn’t wait for the day the external fixator was removed. My son had it in/on for over 4 months to address a leg length discrepancy caused by Ollier Disease and a large bone tumor at the bottom of his femur (thigh bone). Unlike his other surgeries, I was hopeful when they took him behind the OR doors knowing that he would have some relief after this procedure and put this fixator behind us. No more external fixator pin care, dressing over this hunk of metal and onward with normal life…or so I thought…
Initially, we were told that the developing bone was strong and that a cast was not needed. The nurse liaison emerged from behind the door and approached us. He’s done! I thought. Then, before I could say anything she held out what looked like a key-chain with different colored squares on it.
“The doctor said to ask what color cast your son would like.”
“We’re not getting a cast today. The doctor said he wouldn’t need one.”
“Well, he said to ask and I think he’s putting on on.”
“If yes, definitely red than like spider-man.”
She disappeared behind the doors and my nerves shot through the roof. What was wrong? Why now a cast? What would he think when he woke up? I made promises based on this no-cast situation. We booked a trip to the beach (luckily we cancelled it after the cast because a hurricane hit during the time we would have been staying there.) I promised splashing in the bath, playing with his brothers and so on. Huge disappointment.
The cast – a hip spica cast surprise
The surgeon came out and said that he needed to put on a cast because the bone hadn’t formed completely and had been hidden by the fixator during x-rays that were weekly at one point. He would be in a hip spica cast for 3+ weeks and not be allowed to put any pressure on the leg at all. This is also known as non-weight bearing.
My heart just sunk. When will he get to be a kid?
Have you ever tried to keep a 6 year old non-weight bearing? Let’s just say that this is the impossible task. An adult would stay in bed and follow instructions. A child finds ways to hop around on the cast, drag it around on his but and use his toes to hop-run and play.
Waking up from anesthesia
He woke up miserable. The nurse said he had already had pain medicine including toradol, which was awesome after the fixator was placed and nothing else was working, and an antibiotic. After about 20 minutes of screaming he received more medicine and quickly came around.
To my surprise, he looked at the cast and really didn’t care. Thank God, I thought. He was happy it was red and the staff had diapered him.
Soon after he awoke and stopped crying he was discharged. A little soon if you ask me because he was in and out of consciousness. I took him in a wagon, dozing in and out from the anesthesia, to the “cast room” where 2 employees smoothed it out, taped it and they even added a blue stripe so he looked like a spider man costume was permanently on one leg. The 3 of us held him on a tall table that looked like it would be good for a massage therapist while all this was done.
We were discharged while he was still super loopy and allowed to go home the same day! The fixator placement was a one-week hospital stay, this was short in comparison. We did have a long drive ahead of us so they gave him some zofran to help stop the puking. The puking didn’t start until about 2 hours into the trip…luckily we had a basin and he asked for it! Car seat saved!
Hip Spica Cast Care
Caring for the hip spica cast has been really uneventful.
For starters, he’s positioned not quite in a sitting posture and also not standing. It’s awkward and he slides off of the toilet. It took a few tries for him to get it himself…but I had to help hold him so he didn’t fall off of the toilet the first few tries.
We can’t get it wet so we were told that he can’t have a shower or a bath. I wipe him down with a wash cloth series. First wash cloth has soap. Second wash cloth, or cloths if I use too much soap, is for rinsing and then I towel dry. I’ve washed his hair several times over the sink and was told that we can “knock” on the cast for itches and/or use a hair dryer on cool to shoot air up the cast.
Sending air up the cast with a hair dryer turned out to be a no-go for us because it’s so tight that there really isn’t any air flow. I did manage to itch a few spots just a few inches in from the bottom with my finger…making sure not to bunch the fabric inside. Luckily, this only stayed on for a few weeks and I was able to keep him mostly in air-conditioning to help with how hot it made him feel and to keep sweating down. As a child, he doesn’t get really stinky…so heat has been a challenge.
Our journey continues when this comes off!
Have you had a hip spica cast or cared for someone who did?