Spica cast application in the emergency room for select pediatric femur fractures.
OBJECTIVE
This study was designed to evaluate the efficacy and safety of immediate spica casting in the emergency room (ER) and evaluate the effect of discharge from the emergency room on short- term complications.


METHODS
Retrospective review of patients treated with immediate spica casting in the ER between June 1, 1993 and July 30, 2001.


METHODS
Major, pediatric, orthopaedic trauma and referral center.


METHODS
A total of 145 pediatric femur fractures in children, younger than age 7 years, treated with immediate spica casting in the ER were reviewed to determine radiographic outcome and short-term complication rates.


METHODS
All patients underwent immediate spica cast placement in the ER under conscious sedation. Patients meeting specific criteria were discharged immediately from the ER.


METHODS
Radiographic acceptability of alignment at fracture union (angulation, shortening), loss of reduction, number of return visits to the emergency room, and clinical outcome at final follow-up.


RESULTS
Average follow-up was 20 +/- 16 weeks (range, 1-9 months). Forty-eight patients (33%) were discharged from the ER. No clinical complications were noted at last follow-up. All children younger than age 2 years, and 86.5% of children ages 2 to 5 years, met acceptable malalignment parameters on final radiographs. There were 16 ER visits (11%) for cast problems. Re-reduction in the operating room was needed in 11 patients (8.9%); 6.9% of patients had a cast problem noted during follow-up visits. Only 9% of patients developed a major complication. Initial shortening was the only independent risk factor found to be associated with loss of reduction. Admission status had no significant effect on the number of ER visits or development of a complication.


CONCLUSIONS
If there are no associated factors requiring admission (ie, child abuse or polytrauma), spica casting in the ER for pediatric femur fractures followed by immediate discharge can be safely performed with a low complication rate in children younger than age 6 years, nearly eliminating the need for general anesthesia.
Cassinelli
Ezequiel H
EH
Department of Orthopaedic Surgery, Case School of Medicine, Cleveland OH, USA. zekedr@hotmail.com
Young
Brett
B
Vogt
Molly
M
Pierce
Mary Clyde
MC
Deeney
Vincent F X
VF
D002370:Casts, Surgical / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy*; D017102:Fracture Healing; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D010372:Pediatrics / Q000379:methods; D011859:Radiography; D020127:Recovery of Function; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology