Patient Information Resources


Orthogate
1089 Spadina Road
Toronto, AL M5N 2M7
Ph: 416-483-2654
Fax: 416-483-2654
christian@orthogate.com






Ankle
Child Orthopedics
Elbow
Foot
General
Hand
Hip
Knee
Shoulder
Spine - Cervical
Spine - Lumbar
Spine - Thoracic
Wrist

View Web RX

« Back

Safe and Easier Care with Single-Leg Spica Cast for Children

Posted on: 11/30/1999
Young children with a fractured femur (thigh bone) can be treated in a number of different ways. Most involve casting of some sort. To prevent movement and allow the bone to heal, a spica cast is used most often. This type of cast starts at the waist and goes all the way down to the toes.

The spica cast may be single leg or double-leg. The single leg cast ends above the hip on the uninjured side. This type of cast leaves the uninjured leg free to move. The double leg cast immobilizes the injured leg from waist to toes and covers the other hip down to just above the knee. Not being able to bend at the hips (and knee) for four to six weeks presents some difficulties for families caring for young children.

In this study, orthopedic surgeons at The Johns Hopkins Hospital in Baltimore, Maryland compare results between single-leg and double-leg spica casting. The children in the study were all between the ages of two and six with a diaphyseal femoral fracture. The diaphyseal part is the shaft or middle long part of the bone. The hope was to provide an easier way to care for these children using a single-leg cast without compromising the results.

Treatment of diaphyseal femoral fractures with spica casting is considered "best practice" based on recommendations from the American Academy of Orthopaedic Surgeons (AAOS). Cast immobilization avoids surgery with anesthesia, scarring, and the possibility of complications.

Surgeons recognize that even casting has its downside. Skin problems can develop under the cast. Too much pressure can cause swelling causing a compartment syndrome. And, of course, caring for a child in such a bulky cast is no easy task. Transporting the child in the car seat or car, toileting, and lifting and carrying the child are some of the challenges the family members or caretakers face.

But the good news is that the benefits of a single-leg spica cast were very valuable to the families while still resulting in fracture healing. The parents or care givers took fewer days off from work to care for the child.

The single leg cast could be molded with enough hip and knee flexion (bend) to allow the child to sit in a special car seat. And the children with single-leg spica casts could sit in chairs more comfortably. Children in this type of cast could even walk a little bit.

The surgeons conducting this study summarized their recommendations by offering the following opinions:
  • Casting for femoral fractures should be done with a slight angulation called valgus. This can be done by molding the cast. The degree of angle is not standardized; more studies are needed to determine how this can be decided.
  • Children with shortening of the bone due to the fracture will require reduction (restoring the length of the bone) before casting. More than 25 mm of shortening should not be put in a cast until reduction has been done.
  • Long-term studies still need to be done to show the effects of single versus double-leg spica casts for diaphyseal femoral fractures before the single-leg casts are used routinely.

  • References:
    Dirk Leu, MD, et al. Spica Casting for Pediatric Femoral Fractures. In The Journal of Bone and Joint Surgery. July 18, 2012. Vol. 94A. No. 14. Pp. 1259-1264.

    « Back





    *Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.


    All content provided by eORTHOPOD® is a registered trademark of Mosaic Medical Group, L.L.C.. Content is the sole property of Mosaic Medical Group, LLC and used herein by permission.