Hip Spica Cast May Be Useful in Managing Pediatric Femoral Fractures
Young children usually heal quickly when they have a broken or fractured bone. However, they still may be left with some problems after healing has finished. This means that the treating physicians need to choose their treatments carefully, depending on the children's age, how they were injured, how the fracture is, any other injuries, how much treatment will cost, and how the treatment affects other family members.
One type of fracture that can be tricky to treat is the femoral or thigh bone fracture, particularly in younger children. One method favored by most orthopedic surgeons, the doctors who repair these fractures, is the spica cast, according to a survey done in the late 1990s. These casts hold the hips and thighs firmly in place to help healing but there are several types of spica casts. Some start at the chest and cover one or both legs, while others may cover on leg on one side but only part of the leg on the other.
Usually, femoral fractures heal well, especially with spica casts, but there is a common complication for many children: shortening of the broken femur. Surgeons have tried to avoid this by adapting the spica cast, but with only limited success.
One group of researchers, lead by Beuhler, tried to use a so-called telescope test to see if they could identify children at risk of shortening before the casts were applied. They found that if the broken part of the bone overlapped by more than three centimeters before correction, then they had a high likelihood of having a shortened femur after treatment. The authors of this article felt that if they used this test to identify children at risk for shortening, they could use a special spica cast that may help reduce the risk.
Researchers studied 47 patients ranging in age from 18 months to six years. All had fracture femurs and after having the telescope test, they were divided into two groups: one group consisted of patients who have a bone overlap of three centimeters or more, the other group with smaller overlaps. All patients had the same hip spica cast applied within eight hours of the injury and they were all followed with weekly x-rays during the first month, where doctors looked for unacceptable shortening of the femur.
The mean shortening after treatment that the researchers felt was acceptable, was 2.9 millimeters. Sixteen patients in the first group (with more than three centimeters overlap) had femur shortening but only seven patients in the other group did. The researchers felt that any shortening over 25 millimeters (2.5 centimeters) was unacceptable and this did not happen in either group. The alignment for the bone healing was also acceptable in both groups along the front of the bone, but the side of the bone did have a bit of malalignment in several patients in the first group.
The authors concluded that the hip spica cast to treat femoral fractures in young children, which was a first choice treatment for many orthopedic surgeons, could help avoid shortening of the femur during healing. However, the hip spica cast didn't eliminate all problems as seen by the malalignment in some patients.
Ertugrul Aksahin, MD, et al. Immediate Incorporated Hip Spica Casting in Pediatric Femoral Fractures. In Journal of Pediatric Orthopaedics January/February 2009. Vol. 29, No 1. Pp. 39 to 43.