Which treatment option for paediatric femoral fractures in school-aged children: elastic nail or spica casting?

Say, Ferhat; Gürler, Deniz; İnkaya, Erkan; Yener, Kamil; Bülbül, Murat

doi:10.1007/s00590-013-1234-x

Cited by 11 publications

(20 citation statements)

References 22 publications

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“…We found 35 articles specifying accepted varus or valgus angulation 8 , 9 , 11 , 13 – 16 , 18 – 21 , 23 , 25 – 27 , 29 – 31 , 36 , 38 , 41 , 45 , 47 , 48 , 53 , 55 , 56 , 60 , 65 , 69 , 74 , 79 , 80 , 82 , 102 and 34 articles specifying the accepted sagittal plane angulation 8 , 9 , 11 , 13 – 16 , 18 – 21 , 23 , 25 – 27 , 29 , 30 , 36 , 38 , 41 , 45 , 47 , 48 , 53 , 55 , 60 , 65 , 69 , 74 , 76 , 79 , 80 , 82 , 102 . Figure 2 displays the mean and sd of accepted varus/valgus angulation at initial casting based on patient age.…”

Section: Fracture Position Tolerancementioning

confidence: 99%

“…In all, 51 articles specifically mentioned the use or non-use traction in their description of spica application and the course of patient care. Of the articles detailing the use of traction, seven specifically had no traction, 12 , 15 , 23 , 25 , 27 , 61 , 103 12 used isolated skin traction, 20 – 22 , 35 , 36 , 46 , 48 , 53 , 59 , 62 , 68 , 76 and 19 used skeletal traction on some, if not all, of their patients via a Kirschner wire applied to either the distal femur, 10 , 18 , 19 , 24 , 33 , 38 , 41 , 57 , 64 , 67 , 72 , 80 , 94 proximal tibia 13 , 26 , 45 , 97 or unspecified pin location. 52 , 82 Eight retrospective reviews had patients within their cohorts who had received either skin traction or skeletal traction, 17 , 34 , 40 , 56 , 64 , 82 , 86 , 102 but no direct comparison was made between these two treatment options.…”

Section: Techniquesmentioning

confidence: 99%

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Systematic review of spica casting for the treatment of paediatric diaphyseal femur fractures

Tisherman

Hoellwarth

Mendelson

2018

Journal of Children's Orthopaedics

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PurposePaediatric femur fractures are commonly encountered and often successfully managed with spica casting. Despite spica casting’s long history there is little formal guidance for optimal outcomes and no consolidation of existing literature. The purpose of this study is to review the available literature regarding the use of spica casting for the management of paediatric diaphyseal femur fractures.MethodsThe PubMed database was queried for all research articles including the phrase “spica”. A total of 788 abstracts were reviewed for relevance to the current study. Data was extracted from all available research studies which specified tolerance for fracture angulation or shortening in the cast. Additionally, all articles describing alternative materials, methods for spica application, and complications of spica casting were reviewed.ResultsIn all, 106 articles were found relevant to the management of diaphyseal femur fractures in the paediatric population. The aggregated, accepted fracture shortening decreased from 16 mm to 18 mm before age ten years to 12 mm to 14 mm after puberty. Aggregated, accepted angulation decreased from 14° to 16° varus/valgus and 18° to 22° pro/recurvatum before age two years, to 6° to 8° and 10° to 12° by puberty, respectively. The overall reported complication rate was 19.6%, with the most common complication being skin compromise in 8.2% of patients, followed by unacceptable angulation at the fracture site in 4.2% of patients and excessive limb shortening in 1.9% of patients.ConclusionThis article reviews the available spica casting literature and compiles the available data. Spica casting offers a safe, effective means for definitive management of paediatric diaphyseal femur fractures. Future research identifying the rate and pattern of remodelling as it relates to angulation and shortening at various patient ages, particularly beyond the aforementioned norms, would be valuable to identify true biological tolerances versus accepted expert opinion.Level of evidence Level IIReview of level II evidence

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Section: Fracture Position Tolerancementioning

confidence: 99%

Section: Techniquesmentioning

confidence: 99%

Systematic review of spica casting for the treatment of paediatric diaphyseal femur fractures

Tisherman

Hoellwarth

Mendelson

2018

Journal of Children's Orthopaedics

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“…Our proportion of unacceptable final alignment, which criteria was proposed by Cassinelli et al 4 , was comparable to that reported by other studies 20 - 21 . Current literature shows hip spica casting to have a malunion rate from 8.6% to 45% 15 , 20 , 24 . In a direct comparison with Mansour et al’s 10 study for the age group of fewer than two years, their overall rate of unacceptable reduction was 11.1% (3 out of 27) and 40% (2 out of 5) in the outpatient and inpatient cohorts respectively, while we reported 33.3% (2 out of 6) and 12% (3 out of 25).…”

Section: Discussionmentioning

confidence: 99%

Can Paediatric Femoral Fracture Hip Spica Application be Done in the Outpatient Setting?

et al. 2021

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Introduction: Hip spica casting is a standard treatment for children with femur fractures. This study compares the outcomes of spica cast application, in terms of quality of fracture reduction and hospital charges when performed in operating theatre versus outpatient clinics at a local institution. Materials and Methods: A total of 93 paediatric patients, aged between 2 months to 8 years, who underwent spica casting for an isolated femur fracture between January 2008 and March 2019, were identified retrospectively. They were separated into inpatient or outpatient cohort based on the location of spica cast application. Five patients with metaphyseal fractures and four with un-displaced fractures were excluded. There were 13 and 71 patients in the outpatient and inpatient cohort respectively who underwent spica casting for their diaphyseal and displaced femur fractures. Variables between cohorts were compared. Results: There were no significant differences in gender, fracture pattern, and mechanism of injury between cohorts. Spica casting as inpatients delayed the time from assessment to casting (23.55 ± 29.67h vs. 6.75 ± 4.27h, p<0.05), increased average hospital stay (41.2 ± 31.1h vs. 19.2 ± 15.0h, p<0.05) and average hospital charges (US$1857.14 vs US$775.49, p<0.05). Excluding the un-displaced fractures, there were no significant differences in the period of cast immobilisation and median follow-up length. Both cohorts had a similar proportion of unacceptable reduction and revision casting rate. Conclusion: Both cohorts presented similar spica casting outcomes of fracture reduction and follow-up period. With spica cast application in operating theatre reporting higher hospital charges and prolonged hospital stay, the outpatient clinic should always be considered for hip spica application.

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“…Unsurprisingly, the literature does not support one form of fixation over another for length stable fractures in young children when complications and long-term outcomes are taken into account [20,21]. Whereas with length unstable fractures, submuscular plating and flexible nailing has been shown to be more effective than casting [20,[22][23][24][25][26]. In femurs with small canals, plating may be preferable.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the children sustained injury whilst playing; such as trampolining or jumping on a bed, playing in a play area/ nursery and contact sports [12][13][14]. There were many cases of children slipping and falling due to the environment such as a slippery surface or dog lead related injuries [22].…”

Section: Mechanism Of Injurymentioning

confidence: 99%

Changing Demographics of Paediatric Femoral Fractures in a District General Hospital: A 9-year Review

Wartemberg¹,

Ali²,

Davies³

et al. 2021

JOSR

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Which treatment option for paediatric femoral fractures in school-aged children: elastic nail or spica casting?

Cited by 11 publications

References 22 publications

Systematic review of spica casting for the treatment of paediatric diaphyseal femur fractures

Systematic review of spica casting for the treatment of paediatric diaphyseal femur fractures

Can Paediatric Femoral Fracture Hip Spica Application be Done in the Outpatient Setting?

Changing Demographics of Paediatric Femoral Fractures in a District General Hospital: A 9-year Review

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