Related Experiment Video
Updated: Nov 5, 2025
Treatment with Locking Intramedullary Nailing for Intertrochanteric Fracture of the Femur Utilizing a New Awl with a Distal Positioner
Published on: June 6, 2025
Intraoperative Burden of Flexible Intramedullary Nailing and Spica Casting for Femur Fractures in Young Children
Scott A Barnett1, Bryant M Song2, Justin Yan2
1Children's Hospital New Orleans.
Insights
Pediatric femoral shaft fractures treated with Spica casting have a lower intraoperative burden than those treated with flexible intramedullary nails (FINs). Spica treatment involves less anesthesia, fluoroscopy, and radiation exposure compared to FINs.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Trauma surgery
Background:
- Spica casting is the standard treatment for pediatric femoral shaft fractures (ages 6 months-5 years).
- A trend towards flexible intramedullary nails (FINs) for these fractures exists.
- Limited data compares intraoperative patient burden between Spica casting and FINs.
Purpose of the Study:
- To compare the intraoperative burden of Spica casting versus FINs for pediatric femoral shaft fractures.
- Intraoperative burden is defined by anesthetic exposure, fluoroscopic duration, and radiation load.
Main Methods:
- Retrospective chart review of pediatric femoral shaft fractures (2012-2017).
- Comparison between Spica casting and FIN treatment groups.
- Outcomes measured: anesthetic exposure, fluoroscopy time, radiation exposure, length of stay, clinic visits, and complications.
Main Results:
- Spica group (91 patients) and FIN group (52 patients) analyzed.
- Spica treatment had significantly less anesthetic exposure (45.1 min vs. 90.7 min), fluoroscopy time (15.4 s vs. 131.6 s), and radiation load (1.6 mGy vs. 6.9 mGy) compared to FIN.
- No significant differences in length of stay, follow-up visits, or complication rates were observed.
Conclusions:
- Pediatric patients treated with FINs experience a higher intraoperative burden compared to Spica casting.
- FIN treatment is associated with increased exposure to anesthesia, fluoroscopy, and radiation.
- Complication rates were similar between the two treatment methods.
Background:
Spica casting (Spica) remains the widely accepted treatment of closed femoral shaft fractures in young children aged 6 months to 5 years. In some centers, there has been a recent trend towards surgical fixation of these fractures with flexible intramedullary nails (FINs). Despite numerous studies evaluating both Spica and FIN treatment of femoral shaft fractures, there remains a paucity of data regarding patient burden during the intraoperative period. The purpose of this study was to compare the intraoperative burden, defined as anesthetic exposure, fluoroscopic duration, and radiation load, between Spica and FIN treatment of femoral shaft fractures in young children.
Methods:
A retrospective chart review was conducted for pediatric femoral shaft fractures presenting to a tertiary pediatric referral hospital from 2012 to 2017. Comparison groups included pediatric femur fractures treated with Spica and those treated with FIN. Outcomes included anesthetic exposure, fluoroscopy duration, and radiation exposure. In addition, length of stay, clinic visits, and complications were recorded.
Results:
Of 449 consecutive pediatric femur fractures treated at our center, 143 patients ages 2 to 6 years (mean age 3.8±1.4 y) met inclusion criteria. The Spica group contained 91 patients; FIN contained 52 patients. Mean anesthetic exposure was less for Spica compared with FIN [45.1 min, 95% confidence interval (CI): 38.0-52.3 vs. 90.7 min, 95% CI: 80.5-100.8 min; P<0.001]. On average, Spica procedures required less fluoroscopy time compared with FIN (15.4 s, 95% CI: 4.8-26.0 vs. 131.6 s, 95% CI: 117.6-145.6 s; P<0.001). Mean radiation load was less for Spica compared with FIN (1.6 mGy, 95% CI: 0.6-2.6 vs. 6.9 mGy, 95% CI: 5.7-8.1 mGy; P<0.001). There was no difference in length of hospital stay (P=0.831), follow-up visits (P=0.248), or complication rate (P=0.645) between Spica and FIN groups. The most common complication was skin irritation for Spica (18.7%) and symptomatic hardware for FIN (17.3%).
Conclusions:
The findings of this study suggest that pediatric patients with femoral shaft fractures experience an increased intraoperative burden when treated with FIN compared with Spica. Treatment with FIN was associated with increased exposure to anesthesia, fluoroscopic duration, and radiation load despite similar complication rates when compared with Spica.
Level Of Evidence:
Level III.
