Session VIII - Pediatrics/Spine

Saturday, October 14, 2000 Session VIII, Paper #52, 8:19 am

Femoral Shaft Fractures in Children: Traction and Casting versus Intramedullary Nailing

Karl Buechsenschuetz, DO; Charles T. Mehlman, DO, MPH; Elisa Immerman, MBA; K. J. Shaw, MD; Alvin H. Crawford, MD; Dennis R. Roy, MD; E. J. Wall, MD, Children's Hospital Medical Center, Cincinnati, OH

Purpose: The traditional method of treating pediatric femoral shaft fractures, 90­90 traction and spica casting (traction­cast), has recently begun to be replaced by flexible intramedullary nails (FIN). The purpose of our study was to perform a comprehensive cost analysis of traction­cast versus FIN in addition to comparing standard clinical and functional parameters.

Methods: We reviewed all children admitted with a diagnosis of femoral shaft fracture between January 1995 and April 1998. Data from records of patients treated by either of the above methods were analyzed with respect to overall cost, clinical and radiographic outcome, and the results of a telephone interview with a parent. Data were evaluated using Student's t-test and chi square. Sixty-eight patients representing 71 femoral shaft fractures with at least one-year follow-up were included in the study.

Results: Average age at injury was 8 years, 7 months for FIN (range 5 years, 3 months ­ 14 years, 11 months) and 7 years, 2 months for traction/cast (range 3 years, 9 months ­ 10 years, 9 months). There was no significant difference between the 2 groups for standard clinical and functional criteria. FIN was, however, associated with a lower overall cost than traction/cast (mean $10,778.48 for FIN; mean $13,688 for traction-cast). FIN also resulted in a more rapid return to unassisted ambulation (mean 12.9 weeks for FIN; mean 16 weeks for traction-cast), fewer minor complications (P = 0.0001), better scar acceptance (P = 0.04), and higher parent satisfaction (P = 0.0001).

Conclusion: We conclude that lower cost and comparable clinical outcome make FIN superior to traditional traction/cast treatment for femoral fracture care in children.

Significance: To the best of our knowledge this is the first comprehensive analysis of direct costs associated with femur fracture management in children.