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Waterproof Hip Spica Casts for Pediatric Femur Fractures
Jessica L Churchill1, Trinity A Kronk2,3, Mark J Adamczyk3
1Department of Orthopedics, Cleveland Clinic Foundation, Cleveland.
Insights
Waterproof (WP) hip spica casting is safe and effective for pediatric femur fractures, reducing complications and costs compared to traditional (TS) casts. WP casts allow bathing, improving patient and family satisfaction.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Biomaterials in medicine
Background:
- Hip spica casting is standard for pediatric femur fractures (ages 6 months-5 years).
- Traditional spica (TS) casts use cotton padding, preventing bathing.
- Waterproof (WP) casting offers bathing clearance and improved family satisfaction.
Purpose of the Study:
- To evaluate the safety and efficacy of WP hip spica casting for pediatric femur fractures.
- To compare WP casting with traditional TS casting in terms of complications, costs, and outcomes.
Main Methods:
- Retrospective, matched cohort study of pediatric patients (≤5 years) with femur fractures.
- Matched patients treated with WP casts (n=25) to those treated with TS casts (n=25) by age, sex, and fracture type.
- WP casts use fully waterproof materials; TS casts use a Goretex liner and cotton padding.
Main Results:
- No significant differences in operative time, length of stay, or time in cast between WP and TS groups.
- Patient charges were significantly lower for WP casts ($230) versus TS casts ($301).
- Fewer skin/cast complications occurred in the WP group (1 patient) compared to the TS group (9 patients).
Conclusions:
- WP spica casting is safe and efficacious for pediatric femur fractures.
- WP casting significantly reduces skin and cast complications compared to TS casting.
- Fracture healing, alignment, and shortening are similar between WP and TS casts, with added bathing benefit.
Background:
Hip spica casting is the treatment of choice for femur fractures in children ages 6 months to 5 years. Traditional spica (TS) casting utilizes cotton padding that precludes patient bathing. Waterproof (WP) casting has inherent advantages, including clearance for bathing and improved family satisfaction. This study examines the safety and efficacy of WP hip spica casting for the treatment of pediatric femur fractures.
Methods:
This is a retrospective, matched cohort study of patients ≤5 years with a femur fracture treated with hip spica casting. Patients with WP casts were matched to patients with TS casts by age, sex, and fracture type. TS casts utilize a Goretex liner and cotton padding, while WP spicas utilize fully WP materials and can be completely submerged in water.
Results:
Fifty patients were included (25 WP, 25 TS) without differences between cohorts in age, weight, or sex. There were no differences in operative time, length of stay, or length of time in cast. Patient charges were significantly lower in the WP group ($230 vs. $301, P <0.001). At cast-off, coronal/sagittal alignment and shortening were similar, while 9 TS patients had minor skin and/or cast complications that required outpatient repair versus only 1 WP patient ( P <0.001).
Conclusions:
In a matched comparison, WP spica casting significantly reduces skin and cast complications traditionally associated with cotton-based spica casting, with significantly lower charges for WP cast materials. Fracture healing rate, alignment, and shortening at cast-off are similar in WP versus TS casts. WP spica casting is safe and efficacious for pediatric femur fractures, with the inherent advantage of clearance for bathing.
Level Of Evidence:
Level 3.
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