[Treatment of pediatric femur fractures by immediate reduction and spica cast application--clinical and economical feasibility in the Israeli medical system].
BACKGROUND
Pediatric femur fractures are common injuries necessitating immediate application of spica cast or surgical stabilization. Currently, neither conservative nor operative fixation shows superior results; nevertheless, operative intervention has become more common lately. The current study retrospectively investigates short term results of immediate spica cast application, as well as the economic consequences of this treatment.


METHODS
All cases of pediatric (6 months - 6 years) femur fractures treated in a single medium-sized hospital during 3 years were reviewed. Characteristics of fracture treatment and economical aspects were analyzed.


RESULTS
Twenty four patients (17 boys and 7 girls, mean age 2.5 years, range 9 months to 5.5 years), were treated during the study period by immediate closed reduction and spica cast application. Eleven patients were also treated for medical reasons. All cases achieved acceptable alignment and shortening after cast removal. Two patients were re-admitted to the hospital Emergency Room but no changes in treatment were needed, one patient needed re-reduction. Mean hospital stay was 2.75 days. Calculated cost of such treatment is estimated to be almost equal to the compensation given by insurance companies (based on hospital stay in Israel).


CONCLUSIONS
Immediate application of spica cast for pediatric femur fractures, achieves its goals of appropriate fracture-alignment and acceptable complication rates. The authors believe that the compensation should be procedure-based and not hospital-stay based, in a way that will encourage higher efficacy of medical treatment and shortened hospital stay.
Lebel
E
E
Department of Orthopaedic Surgery, Shaare Zedek Medical Center, Jerusalem, Israel. lebel@szmc.org.il
Karasik
M
M
Fisher
D
D
Itzchaki
M
M
D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D006801:Humans; D007223:Infant; D007557:Israel; D007902:Length of Stay; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome