[Femoral shaft fracture in children: treatment with early spica cast]

Abstract

Purpose of the study: Fractures of the femoral shaft are frequent in children and prognosis is good. For children aged less than 7 years, most authors propose orthopedic treatment using prolonged traction then cast immobilization, or orthopedic reduction under general anesthesia and early cast immobilization. The purpose of the present work was to analyze results of orthopedic treatment using a spica early for children aged less than 7 years in comparison with other published series with similar age or management.

Material and method: Forty-seven unselected children aged less than 7 years with a closed fracture of the femoral shaft were treated by orthopedic reduction under general anesthesia and immobilization with a spica cast after a short period (<48 hr) of traction in the plane of the bed. Hip immobilization was set in flexion and minimal abduction, knee in flexion. The children were discharged the day the cast was installed or the next day. Follow-up examinations (tolerance) with x-rays cast in place were scheduled for day 8 and day 15. Clinical and radiological assessment was also recorded at removal of the cast, at 3 months, at 1 year, and at maximum follow-up.

Results: Mean age was 37 months (range 2-83 months). Boys predominated (n=34, 73%). Mean duration of traction was 1.13 days (range 0-5 days). Mean duration of cast immobilization was 45.4 days (range 28-78 days). Mean hospital stay was 2.8 days (range 1-10 days). Four patients (8%) were rehospitalized for secondary displacement under the cast. Weight bearing was effective at day 49 (range 33-78). Mean follow-up was 12.1 months (range 3 months-6 years). Five children (10.5%) developed leg length discrepancy greater than 10 mm. The anatomic axis of the femur in the saggital and frontal planes exhibited deviation in 7 children measuring less than 8 degrees in all cases.

Discussion: The localization and type of fracture observed in this series of children was similar to that reported in epidemiological studies. There were no treatment-related complications. In respect to healing time, deviation, and residual leg length discrepancy, results in this series were equivalent to those reported by others, irrespective of the treatment method employed. The major advantage of early spica is a short hospital stay allowing cost containment and rapid return to the child's everyday environment.