Early versus late hip spica casting for paediatric femoral shaft fractures

Objectives: In non-operative methods, hip spica casting is a gold standard for children under six years of age because of excellent bone union and remodeling qualities. The study was conducted to determine the frequency of limb shortening in femur shaft fractures in children treated by hip spica casting. Study Design: Descriptive cross sectional study. Setting: Orthopedics Department of Combined Military Hospital, Rawalakot, Pakistan. Period: One year from July, 2016 to June, 2017. Material and Methods: After approval of the study from institution’s ethical committee, all patients fulfilling the inclusion criteria were admitted through emergency or outpatient department for hip spica casting. It was descriptive cross sectional study and sampling was done by non-probability convenience sampling in 107 femur fracture patients treated by hip spica casting. Diagnosis of the fracture was based upon history of trauma with break in the continuity of shaft as seen by X-ray. Informed consent was obtained from parents/guardian to be included in the study. Results: The mean age was 5(± 2.04) years. Sixty eight percent patients were male and 32% were female. Sixty three percent patients had proximal femoral shaft fracture, 32% had middle femoral shaft fracture and 4% patients had distal femoral shaft fracture. The shortening of limb length was found in14% of patients. Conclusion: In closed femoral shaft fractures, hip spica casting is a safe treatment in children. It has a low risk of complications. We recommend its use except for open fractures, multiple fractures, or fractures in older children.

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A comparative study of the management of pediatric femoral shaft fractures treated conservatively with traction or spica casting

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20202687 ◽

2020 ◽

Vol 6 (4) ◽

pp. 793

Author(s):

Akash Shakya ◽

Ghanshyam Kakadiya ◽

Yogesh Soni ◽

Vinayak Garje

Keyword(s):

Tertiary Care ◽

Young Patients ◽

Femoral Shaft ◽

Care Hospital ◽

Older Children ◽

Femoral Shaft Fractures ◽

Spica Casting ◽

Orthopedic Surgeons ◽

Shaft Fractures ◽

A Prospective Study

Background: Femoral shaft fractures, though not very common, are of major concern for orthopedic surgeons. the management for infants and older children is generally universal but the young patients still offer a management dilemma.Methods: We present a prospective study conducted at a tertiary care hospital in India of 37 children between 1 year and 6 years to compare the two conservative methods most commonly used i.e. spica casting and traction application.Results: We found that though both the methods are similar in the time for union, shortening was better controlled with traction and angulation with spica casting. The frequency of other complications was also comparable.Conclusions: Both the methods give acceptable results and given the feasibility of such procedures in developing countries, both may be recommended. However, the choice thus depends on the surgeon treating the patient keeping in mind the drawbacks and limitations of each.

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Fracture characteristics predict suboptimal alignment in preschool femoral shaft fractures treated with spica casting: a retrospective chart review

Current Orthopaedic Practice ◽

10.1097/bco.0000000000000878 ◽

2020 ◽

Vol 31 (4) ◽

pp. 379-384

Author(s):

Amir Misaghi ◽

Mahmoud A. H. Mahmoud ◽

Alexandre Arkader ◽

Keith D. Baldwin

Keyword(s):

Chart Review ◽

Femoral Shaft ◽

Retrospective Chart Review ◽

Fracture Characteristics ◽

Femoral Shaft Fractures ◽

Spica Casting ◽

Shaft Fractures ◽

Suboptimal Alignment

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Traction and Spica Casting for Closed Femoral Shaft Fractures in Children

Journal of Orthopaedic Surgery ◽

10.1177/230949900701500109 ◽

2007 ◽

Vol 15 (1) ◽

pp. 37-40 ◽

Cited By ~ 12

Author(s):

YHD Lee ◽

KBL Lim ◽

GX Gao ◽

A Mahadev ◽

KS Lam ◽

...

Keyword(s):

Femoral Shaft ◽

Femoral Shaft Fractures ◽

Spica Casting ◽

Shaft Fractures ◽

Fractures In Children

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Treatment of closed femoral shaft fractures in children aged 2–10 years: a systematic review and meta-analysis

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01752-7 ◽

2021 ◽

Author(s):

Stijn van Cruchten ◽

Eefke C. Warmerdam ◽

Dagmar R. J. Kempink ◽

Victor A. de Ridder

Keyword(s):

Systematic Review ◽

Subgroup Analysis ◽

Weight Bearing ◽

Femoral Shaft ◽

Treatment Modalities ◽

Full Weight Bearing ◽

Femoral Shaft Fractures ◽

Spica Casting ◽

Shaft Fractures ◽

Fractures In Children

Abstract Objective To review current literature on treatment of closed femoral shaft fractures in children of 2–10 years old, with subgroup analysis of children aged 2–6 years, comparing intramedullary nailing (IMN) to conservative treatment modalities. Methods We included clinical trials and observational studies that compared traction and subsequent casting (TSC), spica casting and IMN for treatment of femur shaft fractures in children of 2–10 years of age. Subgroup analysis of children aged 2–6 years was performed. Results Compared to treatment with immediate spica casting, IMN led to significantly less coronal angulation (mean difference (MD): 2.03 degrees, confidence interval (CI) 1.15–2.90), less sagittal angulation (MD: 1.59 degrees, CI 0.82–2.35) and lower rates of LLD (Risk difference (RD): 0.07, CI 0.03–0.11). In terms of rehabilitation, IMN leaded to shorter time until walking with aids (MD: 31.53 days, CI 16.02–47.03), shorter time until independent ambulation (MD: 26.59 days, CI 22.07, 31.11) and shorter time until full weight bearing (MD: 27.05 days, CI 6.11, 47,99). Compared to TSC, IMN led to a lower rate of malunion (RD: 0.31, CI 0.05–0.56), shorter hospital stays (MD: 12.48 days, CI 11.57, 13.39), time until walking with aids (MD: 54.55, CI 40.05–69.04) and full weight bearing (MD: 27.05 days [6.11, 47,99]). Conclusion Although a lack of quality evidence, this systematic review showed a clear tendency to treatment with elastic intramedullary nails of femoral shaft fractures in children of 2–10 years of age. Level of evidence 3.

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