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Immediate single-leg spica cast for pediatric femoral diaphysis fractures
Howard R Epps1, Emily Molenaar, Daniel P O'connor
1Fondren Orthopedic Group, L.L.P., Baylor College of Medicine, Houston, TX 77030, USA. epps@fondren.com
Insights
Single-leg spica casts effectively manage femur fractures in young children, allowing most to regain mobility and return to school. This method offers a safe and functional treatment option with minimal complications.
Area of Science:
- Pediatric Orthopedics
- Traumatology
- Biomechanical Engineering
Background:
- Femur fractures are common in young children.
- Immediate spica cast application is the standard treatment.
- Single-leg spica casts are an alternative treatment option.
Purpose of the Study:
- Evaluate the outcomes and functional level of children treated with single-leg spica casts.
- Assess the safety and efficacy of single-leg spica casts for pediatric femur fractures.
- Investigate potential social benefits of single-leg spica casts.
Main Methods:
- Retrospective review of 45 children with isolated femur fractures treated with single-leg spica casts.
- Data collected included demographics, injury mechanism, hospitalization time, cast duration, and complications.
- Functional outcomes assessed via physical examination, radiographs, and the Activities Scale for Kids questionnaire.
Main Results:
- Most children (62%) walked with assistive devices or independently.
- High functional scores (median 95/100 on Activities Scale for Kids) were observed.
- Low complication rates, with two failures due to shortening and two requiring repeat reduction; five casts broke.
Conclusions:
- Single-leg spica casts provide a safe and effective treatment for low-energy femur fractures in children.
- This method supports functional recovery and may mitigate social concerns associated with traditional spica casts.
Purpose:
Immediate spica cast application is the standard of care for young children with isolated femur fractures. We evaluated the outcomes and function of children treated with single-leg spica casts.
Methods:
We performed a retrospective review of 45 children treated with single-leg spica casts. Demographic data, mechanism of injury, hospitalization time, time in cast, and complications were collected by chart review. Children returned for a physical examination and radiographs. Subjects completed a questionnaire about the child's functional level and the Activities Scale for Kids.
Results:
There were 33 boys and 12 girls. The average age was 3.3 (9 months to 9 years). The mechanism of injury was a fall in 71%. The mean hospitalization was 1 day (0-4 days) and the mean time to union was 6 weeks (4-9 weeks). Ninety-five percent of the patients crawled in the cast, 90% pulled to stand, 81% cruised, and 62% walked either independently or with assistive devices. One half of the patients in school or daycare returned while in the cast. Two children failed because of unacceptable shortening. Two children required repeat reductions under anesthesia due to unacceptable alignment. Five casts broke at the hip joint. At final review, there was 1 rotational malunion. There were no radiographic malunions. The median Activities Scale for Kids score was 95 of 100 possible points.
Conclusions:
The single-leg spica can safely, effectively manage low-energy femur fractures in young children.
Significance:
The single-leg spica may address some of the social concerns associated with the use of a spica cast for simple femur fractures.
