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Spica casting for pediatric femoral fractures: a prospective, randomized controlled study of single-leg versus
Dirk Leu1, M Catherine Sargent, Michael C Ain
1Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Bayview Medical Center, 4940 Eastern Avenue, #A665, Baltimore, MD 21224-2780, USA. ehenze1@jhmi.edu
Insights
Single-leg spica casting is an effective and safe treatment for pediatric femoral fractures. This method simplifies care and improves patient function compared to double-leg casting.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Traumatology
Background:
- Double-leg spica casting is standard for pediatric diaphyseal femoral fractures in children aged 2-6.
- A hypothesis proposed single-leg spica casting as a potentially easier and more functional alternative.
Purpose of the Study:
- To compare the efficacy and patient-reported outcomes of single-leg versus double-leg spica casting for pediatric diaphyseal femoral fractures.
Main Methods:
- A prospective, randomized controlled trial involved 52 children (2-6 years) with femoral fractures.
- Patients were randomized to receive either single-leg (24) or double-leg (28) spica casts.
- Radiographic assessment evaluated fracture alignment; validated questionnaires assessed functional outcomes and ease of care.
Main Results:
- All fractures healed with satisfactory alignment.
- Children in the single-leg cast group showed improved car seat and chair accessibility (p < 0.05).
- Caregivers reported less work absence with single-leg casting (p < 0.05), with no major complications.
Conclusions:
- Single-leg spica casting is a safe and effective treatment for pediatric femoral fractures.
- This approach significantly facilitates post-fracture care and improves patient function.
Background:
At many centers, double-leg spica casting is the treatment of choice for diaphyseal femoral fractures in children two to six years old. We hypothesized that such patients can be effectively treated with single-leg spica casting and that such treatment would result in easier care and better patient function during treatment.
Methods:
In a prospective, randomized controlled study, fifty-two patients two to six years old with a diaphyseal femoral fracture were randomly assigned to be treated immediately (after consent was obtained) with a single-leg (twenty-four patients) or double-leg (twenty-eight patients) spica cast. Serial radiographs were evaluated for maintenance of fracture reduction with respect to limb length, varus/valgus angulation, and procurvatum/recurvatum angulation. After cast removal, the performance version of the Activities Scale for Kids questionnaire and a custom-written survey were administered to the parents so that they could evaluate the ease of care and function of the children during treatment. Means were compared between treatment groups with use of Student t tests. P values of <0.05 were considered significant.
Results:
All limbs healed in satisfactory alignment. The children treated with a single-leg spica cast were more likely to fit into car seats (p < 0.05) and fit more comfortably into chairs (p < 0.05). Caregivers of patients treated with a single-leg cast took less time off work (p < 0.05). There were no major complications.
Conclusions:
Treatment of pediatric femoral fractures with a single-leg spica cast is effective and safe, and postfracture patient care is facilitated.
Level Of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
