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Published on: August 14, 2018
Short Leg Cast Versus Long Leg Cast Immobilization for Pediatric Tibia Fractures: A Systematic Review and
Alma Sato1, Yasmine J Khair1, Angelica Pashou1
1University of Nicosia Medical School, University of Nicosia, Nicosia, Cyprus.
Insights
Short leg casts (SLC) may be a viable alternative to long leg casts (LLC) for pediatric tibial fractures, showing similar healing and complication rates. SLCs were associated with faster weight-bearing and union times in this review.
Area of Science:
- Orthopedics
- Pediatric Traumatology
- Evidence-Based Medicine
Background:
- Pediatric tibial fractures are common, but optimal immobilization remains unclear.
- Comparative effectiveness of short leg casts (SLC) versus long leg casts (LLC) is not well-established.
Purpose of the Study:
- To compare the effectiveness and safety of SLC versus LLC for pediatric tibial fractures.
- To evaluate healing stability, functional recovery, and complication rates.
Main Methods:
- Systematic review and meta-analysis of retrospective comparative studies (Level III evidence).
- Literature search of Medline, CINAHL, Embase, and Cochrane Library up to August 2025.
- Random-effects model for statistical analysis following PRISMA guidelines.
Main Results:
- Six studies with 413 pediatric patients were included (163 SLC, 250 LLC).
- No significant differences in coronal or sagittal angulation, cast duration, or overall complication rates between SLC and LLC.
- SLC associated with shorter time to weight-bearing and faster time to union.
Conclusions:
- SLC may be considered an alternative to LLC for pediatric tibial shaft and distal tibial physeal fractures.
- Evidence is limited by retrospective designs and heterogeneity; further prospective studies are needed.
- Optimal indications for SLC require further definition through prospective research.
Background:
Pediatric tibial fractures are common long-bone injuries, yet uncertainty remains in the optimal immobilization strategy. The comparative effectiveness and safety of short leg versus long leg casts in achieving stable healing and functional recovery have not been clearly established.
Methods:
A literature search was conducted across Medline, CINAHL, Embase, and Cochrane Library, from inception to August 2025, following PRISMA guidelines and registered with the International Prospective Register of Systematic Reviews (PROSPERO). Statistical analyses were performed using a random-effects model.
Results:
The initial search yielded 1236 studies; 6 studies with 413 pediatric patients met the inclusion criteria. A total of 163 underwent short leg casting (SLC) and 250 long leg casting (LLC). No differences were observed between SLC and LLC for coronal angulation (MD=0.12 degrees, 95% CI=-0.89 to 1.12, I2 =58%) or sagittal angulation (MD=0.18 degrees, 95% CI=-0.71 to 1.07, I2 =56%). Subgroup analyses showed no differences for tibial shaft fractures or Salter-Harris distal tibial fractures. Cast duration was similar between groups (MD=-0.74 wk, 95% CI=-1.49 to 0.01, I2 =92%). Overall complication rates did not differ (OR=0.76, 95% CI=0.25 to 2.34, I2 =0%), with no differences in Salter-Harris subgroup analysis (OR=0.67, 95% CI=0.05 to 9.91; I2 =54%). SLC was associated with shorter time to weight-bearing (MD=-2.29, 95% CI=-4.49 to -0.08, I2 =68%) and faster time to union (MD=-1.21, 95% CI=-2.16 to -0.25, I2 =30%).
Conclusion:
SLCs may be considered as an alternative to LLCs in pediatric tibial shaft and distal tibial physeal fractures based on currently available retrospective comparative evidence. However, the evidence is limited by the retrospective design, clinical heterogeneity, and risk of confounding. Further prospective comparative studies are needed to define optimal indications for SLC use in this population.
Level Of Evidence:
Level III, systematic review and meta-analysis of retrospective comparative studies.
