title: Dynamic skeletal traction spica casts for paediatric femoral fractures in a resource-limited setting.
abstract: The objective of this study was to compare elastic intramedullary nailing (EIN) with dynamic skeletal traction spica casting (DSTSC) in terms of postoperative radiographic angulations, length of hospital stay, and cost in a resource-limited setting. We prospectively studied 51 children, five to twelve years of age, with femoral fractures treated with either EIN (n = 26) or DSTSC (n = 25). Children treated with EIN had significantly longer hospital stays (17 +/- 8.0 days) than those treated with DSTSC (6.0 +/- 2.5 days). Financial constraints in acquiring supplies caused a significant increase in time from admission to surgery (EIN 9.5 +/- 2.3 days; DSTSC 1.1 +/- 0.3 days), and cost was about 400% higher for EIN compared with DSTSC. At twelve weeks follow-up, all patients in both groups had acceptable radiographic angulations. In resource-limited healthcare settings, DSTSC is an effective alternative to EIN with comparable post-op radiographic angulations, decreased hospital stays, and lower cost.
authors.affiliation: Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA 94304-5709, USA. andyhsu1@gmail.com
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Hsu
authors.forename: Hilario M
authors.initials: HM
authors.lastname: Diaz
authors.forename: Noel Rex P
authors.initials: NR
authors.lastname: Penaranda
authors.forename: Heherson D
authors.initials: HD
authors.lastname: Cui
authors.forename: Rowena Helena A
authors.initials: RH
authors.lastname: Evangelista
authors.forename: Lawrence
authors.initials: L
authors.lastname: Rinsky
authors.forename: Ranulfo V
authors.initials: RV
authors.lastname: Gracilla
mesh_terms: D001858:Bone Nails; D002370:Casts, Surgical / Q000191:economics*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005264:Femoral Fractures / Q000191:economics / Q000628:therapy*; D005594:Fracture Fixation, Intramedullary / Q000191:economics / Q000295:instrumentation / Q000379:methods; D017102:Fracture Healing; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics*; D006801:Humans; D007902:Length of Stay; D008297:Male; D011446:Prospective Studies; D016059:Range of Motion, Articular; D014143:Traction / Q000295:instrumentation* / Q000379:methods