Spica casting for pediatric femoral fractures: a prospective, randomized controlled study of single-leg versus double-leg spica casts.
BACKGROUND
At many centers, double-leg spica casting is the treatment of choice for diaphyseal femoral fractures in children two to six years old. We hypothesized that such patients can be effectively treated with single-leg spica casting and that such treatment would result in easier care and better patient function during treatment.


METHODS
In a prospective, randomized controlled study, fifty-two patients two to six years old with a diaphyseal femoral fracture were randomly assigned to be treated immediately (after consent was obtained) with a single-leg (twenty-four patients) or double-leg (twenty-eight patients) spica cast. Serial radiographs were evaluated for maintenance of fracture reduction with respect to limb length, varus/valgus angulation, and procurvatum/recurvatum angulation. After cast removal, the performance version of the Activities Scale for Kids questionnaire and a custom-written survey were administered to the parents so that they could evaluate the ease of care and function of the children during treatment. Means were compared between treatment groups with use of Student t tests. P values of &lt;0.05 were considered significant.


RESULTS
All limbs healed in satisfactory alignment. The children treated with a single-leg spica cast were more likely to fit into car seats (p &lt; 0.05) and fit more comfortably into chairs (p &lt; 0.05). Caregivers of patients treated with a single-leg cast took less time off work (p &lt; 0.05). There were no major complications.


CONCLUSIONS
Treatment of pediatric femoral fractures with a single-leg spica cast is effective and safe, and postfracture patient care is facilitated.


METHODS
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Department of Orthopaedic Surgery, The Johns Hopkins University/Johns Bayview Medical Center, 4940 Eastern Avenue, #A665, Baltimore, MD 21224-2780, USA. ehenze1@jhmi.edu
Dirk
D
Leu
M Catherine
MC
Sargent
Michael C
MC
Ain
Arabella I
AI
Leet
John E
JE
Tis
Paul D
PD
Sponseller
D000203:Activities of Daily Living; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D018483:Diaphyses; D005260:Female; D005264:Femoral Fractures / Q000000981:diagnostic imaging / Q000628:therapy*; D005592:Fracture Fixation / Q000379:methods*; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011446:Prospective Studies; D011859:Radiography; D014481:United States