Femoral-shaft fractures in children: a comparison of immediate casting and traction

Two hundred fifty-three femoral-shaft fractures in 246 pediatric patients treated between 1976 and 1986 were retrospectively reviewed, and 186 fractures in 181 patients were available for demographic review. Fifty-nine patients underwent spica casting within 48 h of injury, whereas 127 were placed in traction and underwent delayed casting (>48 h from injury). Fifty-five patients in the traction group and 33 in the immediate-casting group were locatable for long-term follow-up of 8.9 years average (range, 4-20 years). There was no clinically significant difference in limb-length inequalities, or rotational or angular deformities between the two groups at initial casting or at final follow-up. Hospital stay averaged 17.3 days in the traction group and 2.2 days in the immediate-casting group (p < 0.001). Total estimated charges, at current rates, demonstrated an 83% greater patient charge in the traction group than in the immediate-casting group.