Session VIII - Pediatrics
Sat, 10/9/04 Pediatrics, Paper #46, 3:25 pm
Immediate Single-Leg Spica Cast for Pediatric Femur Fractures
Purpose: Immediate spica cast application is the standard of care for young children with isolated femur fractures. Several authors have documented the difficulties of caring for a child in a one and one-half spica cast. We evaluated the outcomes and function of children treated with immediate single-leg spica casts.
Methods: We performed a retrospective review of the records of all children with femur fractures treated with single-leg spica casts by a single surgeon between July 1996 and December 2002. Demographic data, mechanism of injury, hospitalization time, time in cast, and complications were collected by chart review. Radiographs at time of cast removal were measured for angulation. All children were asked to return for a physical examination and radiographs and were observed for at least 6 months. Parents completed a questionnaire about the child's functional level in the cast, and eligible subjects completed the Activities Scale for Kids (ASK).
Results: Forty-five patients, 32 boys and 13 girls, met the inclusion criteria. The average age was 3.1 years (range, 11 months to 9 years). The mechanism of injuries were a fall, 55%; fall from playground equipment, 15%; and fall from furniture, 10%. Five percent of the children were involved in a motorized vehicle accident. All fractures were classified as 32A1.2, 32A2.2, 32A3.2, or 32B1.2. The average hospital stay was 1 day. Average time to union was 6 weeks. Ninety-five percent of the patients crawled in the cast, 90% pulled to stand, and 80% cruised. Sixty percent walked independently or with assistive devices. Average time in the cast was 6 weeks (range, 4 to 8 weeks). Of patients who attended school or daycare, 57% were able to return in the cast after an average of 1.9 weeks. Eighty percent of parents reported missing work to care for their child. Parents reported missing an average of 1.7 weeks (range, 2 days to 8 weeks) from work. Patients resumed walking an average of 4 days after cast removal and returned to normal function after an average of 43 days. One child's cast was exchanged to an external fixator, and one child was placed in skeletal traction for 7 days because of unacceptable shortening. Two casts required wedging during treatment. The casts of five patients broke at the hip joint, requiring reinforcement or discontinuation of the cast because the fracture had healed. Two children required repeat reductions under anesthesia to correct unacceptable alignment. Twenty-one patients returned for final review. There was one rotational malunion. Six children had a difference in leg lengths, which averaged 0.8 cm (range, 0 to 1.0 cm). There were no radiographic malunions at final review. Average angulation was 4° in the frontal plane and 11° in the sagittal plane. The median ASK score was 89 points (range, 62 to 100 points) out of 100 possible points.
Conclusion: The single-leg spica cast can safely and effectively be used to manage low-energy femur fractures in young children. Outcomes are excellent with less restriction of mobility during treatment. One should apply these results with caution to high-energy injuries or more complex fracture patterns.
Significance: The single-leg spica may address some of the social concerns associated with use of a spica cast for simple femur fractures.