Malcolm had another doctor’s appointment on 3rd June and the cast had been on for over 7 weeks. His x-ray confirmed the new bone tissue all around the break was dense enough and it was time to take off the cast. He was very brave, despite the clinician having a difficult time removing the cast. The French medical team made it very strong and it DID prove itself robust but the slight downside is that it wasn’t easy to remove. I had to help a bit but it was all ok in the end.
The leg was tender and the skin sensations overwhelmed him a bit and he was itchy where the cast had been. His bad leg surprisingly hadn’t lost any mass or tone. We think he was flexing it inside the cast the last couple of weeks, pumping it which helped get him ready to walk again. Another factor was not having the “boat anchor” weight of the cast on his body which de-stabilized him somewhat. A big benefit for weary parents was that he felt feather-light to carry!!
For the rest of the day of the cast removal he wasn’t interested in moving around on his own although he did test his weight a couple of times. He asked to sit in the car, as he hadn’t been able to do so for 2 months. I managed to snap this photo. Next photo is the day after after removal where he made up his mind to start walking. To celebrate we had a little picnic on the back patio that evening.
We were very fortunate to have wonderful sunny and WARM weather that week. Doing stuff outside helped motivate Malcolm to join in some fun with less fear. The photos below were taken 2 days after cast removal - 5th June. Malcolm had gained a lot of upper body muscle tone dragging himself around with that cast for 2 months – he looks ripped!
His knee was very stiff and that took some time to loosen up. He had been practicing the Captain Pegleg walk the last week or so with the cast on and his balance on his feet was fine. He had difficulty with stairs for a while but that gradually improved. For this age of patient, they don’t recommend any proper physiotherapy. Parents are just told to let them go and watch over them to make sure they aren’t doing too much too soon!
From what we were told (and backed up by research on the internet), two of the most important risk factors for Malcolm’s type of break are:
1) Foot angle - in some cases the leg is set in a way that makes the foot permanently angled out or in from where it was previously. In our case, we observed that his foot was pointed straight ahead, symmetric to the good leg. WHEW!
2)Femur length – as mentioned in a previous post, patients at this age experience “overgrowth” of injured bones. When setting a break, doctors intentionally set the bone shorter in expectation of the overgrowth. This involves some guesswork blended with a LOT of knowledge of patient factors (exact age, physiology, general health, etc). Scary stuff when you think about it and if leg length parity is not achieved there are even more scary ways to address it.
In the initial weeks after cast removal, his repaired leg appeared shorter than the good leg which was as expected. His limp made it seem especially noticeable. However after approximately two months, the limp was gone and the legs appeared even in length. This proved to be the case many months after – mother nature was correctly regulating the length of both legs. DOUBLE WHEW!
Here’s a short raw video of him walking the day after cast removal.
