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Review
. 2024 Jun 6:53:102438.
doi: 10.1016/j.jcot.2024.102438. eCollection 2024 Jun.

Single-leg versus double-leg hip spica casts in the management of paediatric femoral shaft fractures? A systematic review and meta-analysis

Alexander Curtis  1   2 , Sean Scattergood  1   2 , Oliver Beaumont  1   3 , Miss Lydia Jenkins  1   4 , Sameera Abas  1   5 , Abdul Hassan  1   2 , Felix Morriss  2
Affiliations
Review

Single-leg versus double-leg hip spica casts in the management of paediatric femoral shaft fractures? A systematic review and meta-analysis

Alexander Curtis et al. J Clin Orthop Trauma. .

Abstract

Background: Paediatric femoral shaft fractures can be managed with single- or double-leg hip spica casting between ages six-months and six-years. The aim of this review was to determine if single-leg hip spicas reduce the impact on family life without compromising fracture stability.

Methods: The study was registered on PROSPERO (CRD42023454309). MEDLINE, Embase, Web of Science, Cochrane Library, and clinical trial registers were searched to May 2023 for level I-III evidence. Primary outcomes were impact on family life and fracture stability. Where appropriate, Meta-analysis was completed using RevMan v5.4. Risk of bias was assessed using RoB 2.0 (RCTs) and ROBINS-I (non-RCTs). Certainty of evidence was measured with GRADE.

Results: From 234 identified papers, four met the inclusion criteria (two RCTs; two non-RCTs). A total of 339 children were included (single-leg spica: 176; double-leg spica: 163). Three studies were 'high risk' and one study 'moderate risk' of bias. Impact on family life parameters were too heterogenous for pooled meta-analysis. Non-pooled data identified significantly more missed work days in the double-leg spica group and the 'Impact on Family' Scale significantly favoured single-leg spicas. For fracture stability, meta-analysis identified that (i) mal-union rates were significantly lower in single-leg spica: OR 0.08 (95 % CI 0.01 to 0.69; p = 0.02); (ii) MUA in theatre was not significantly different: OR 0.97 (95 % CI 0.19 to 4.86; p = 0.97); and (iii) wedge adjustment was not significantly different: OR 3.46 (95 % CI 0.48 to 24.92; p = 0.22). Certainty of evidence was assessed as 'very low'.

Conclusion: Single-leg hip spicas may be associated with reduced impact on family life without compromising fracture stability compared with double-leg hip spicas. However, the evidence is weak. Therefore, a propensity score matched observational study is required to understand if subgroups of patients (age, fracture pattern, mechanism of injury) would benefit from a single- or double-leg hip spica.

Keywords: Double-leg; Femur; Fracture; Hip spica; Paediatric; Pediatric; Single-leg; Spica casting.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram.
Fig. 2
Fig. 2
Risk of bias (RoB 2.0).
Fig. 3
Fig. 3
Risk of bias (Robins i).
Fig. 4
Fig. 4
Forest plot comparing single-vs double-leg hip cast rate of mal-union.
Fig. 5
Fig. 5
Forest plot comparing single-vs double-leg hip spica cast need for repeat MUA in theatre.
Fig. 6
Fig. 6
Forest plot comparing single-vs double-leg hip spica cast need for wedge adjustment in clinic.
Fig. 7
Fig. 7
Forest plot comparing single-vs double-leg hip spica cast ability to mobilise independently.
See this image and copyright information in PMC

References

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