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Spica cast application in the emergency room for select pediatric femur fractures
Ezequiel H Cassinelli1, Brett Young, Molly Vogt
1Department of Orthopaedic Surgery, Case School of Medicine, Cleveland OH, USA. zekedr@hotmail.com
Insights
Immediate spica casting in the emergency room (ER) for pediatric femur fractures is safe and effective for children under 6. Most patients can be discharged directly from the ER, minimizing the need for general anesthesia.
Area of Science:
- Pediatric Orthopedics
- Trauma Surgery
- Emergency Medicine
Background:
- Pediatric femur fractures are common injuries in children.
- Traditional management often requires hospitalization and general anesthesia for casting.
- Immediate spica casting in the emergency room (ER) offers a potential alternative.
Purpose of the Study:
- To evaluate the efficacy and safety of immediate spica casting in the ER for pediatric femur fractures.
- To assess the impact of ER discharge on short-term complications.
Main Methods:
- Retrospective review of 145 pediatric femur fractures in children under 7 years old.
- Immediate spica casting performed in the ER under conscious sedation.
- Patients meeting specific criteria were discharged directly from the ER.
Main Results:
- 33% of patients were discharged from the ER without immediate complications.
- Acceptable radiographic alignment was achieved in most children, particularly those under 5 years.
- 11% of patients had ER visits for cast issues, and 8.9% required re-reduction.
- Major complications occurred in only 9% of patients.
Conclusions:
- Immediate spica casting in the ER is a safe and effective treatment for pediatric femur fractures in children under 6, when no other factors necessitate admission.
- Discharging patients directly from the ER after casting is feasible and associated with a low complication rate.
- This approach can significantly reduce the need for general anesthesia in managing these fractures.
Objectives:
This study was designed to evaluate the efficacy and safety of immediate spica casting in the emergency room (ER) and evaluate the effect of discharge from the emergency room on short- term complications.
Design:
Retrospective review of patients treated with immediate spica casting in the ER between June 1, 1993 and July 30, 2001.
Setting:
Major, pediatric, orthopaedic trauma and referral center.
Patients:
A total of 145 pediatric femur fractures in children, younger than age 7 years, treated with immediate spica casting in the ER were reviewed to determine radiographic outcome and short-term complication rates.
Intervention:
All patients underwent immediate spica cast placement in the ER under conscious sedation. Patients meeting specific criteria were discharged immediately from the ER.
Main Outcome Measurements:
Radiographic acceptability of alignment at fracture union (angulation, shortening), loss of reduction, number of return visits to the emergency room, and clinical outcome at final follow-up.
Results:
Average follow-up was 20 +/- 16 weeks (range, 1-9 months). Forty-eight patients (33%) were discharged from the ER. No clinical complications were noted at last follow-up. All children younger than age 2 years, and 86.5% of children ages 2 to 5 years, met acceptable malalignment parameters on final radiographs. There were 16 ER visits (11%) for cast problems. Re-reduction in the operating room was needed in 11 patients (8.9%); 6.9% of patients had a cast problem noted during follow-up visits. Only 9% of patients developed a major complication. Initial shortening was the only independent risk factor found to be associated with loss of reduction. Admission status had no significant effect on the number of ER visits or development of a complication.
Conclusions:
If there are no associated factors requiring admission (ie, child abuse or polytrauma), spica casting in the ER for pediatric femur fractures followed by immediate discharge can be safely performed with a low complication rate in children younger than age 6 years, nearly eliminating the need for general anesthesia.
