Flynn, J Bone Joint Surg Am 2011 - The Treatment of Low-Energy Femoral Shaft Fractures: A Prospective Study Comparing the “Walking Spica” with the Traditional Spica Cast

The Treatment of Low-Energy Femoral Shaft Fractures: A Prospective Study Comparing the “Walking Spica” with the Traditional Spica Cast

Flynn, Wells, et al.·J Bone Joint Surg Am·2011·54 citations·Prospective cohort

Background

A single-leg, walking hip spica cast has been shown to be a safe and effective treatment for a low-energy femoral shaft fracture in young children. We designed a prospective cohort trial comparing walking and traditional hip spica casting to determine whether a walking hip spica cast was superior to a traditional hip spica cast following a low-energy femoral shaft fracture in children one to six years old.

Methods

We studied 45 consecutive low-energy femoral shaft fractures during a 3-year period in children one to 6 years old.
3 surgeons treated their patients with a walking hip spica cast, and 3 other surgeons treated their patients with a traditional spica cast.
Complications and subsequent interventions were recorded prospectively.
Caregivers were asked to complete the validated Impact on Family Scale as well as a 10-item questionnaire developed by the authors at the time of cast removal.

Results

45 patients with a low-energy fracture were enrolled in the study.
19 patients were treated with a walking hip spica cast and 26, with a traditional hip spica cast.
The 2 cohorts were similar with respect to age, length of hospital stay, time to initial callus formation, and time to fracture union.
2 children treated with a traditional hip spica cast and no children in the walking hip spica group returned to the operating room for the treatment of spontaneous loss of fracture reduction.
5 of the 19 children treated with a walking hip spica cast and one of the 26 treated with a traditional hip spica cast required wedge adjustment of the cast in the clinic to treat fracture malalignment (p = 0.04).
One patient treated with a walking hip spica cast required repeat reduction in the operating room because of overcorrection during wedge adjustment.
The malunion rate did not differ significantly between the groups (3 of 26 in the traditional hip spica group compared with none of 19 in the walking hip spica group).
All patients treated with a walking hip spica cast were able to crawl in the cast, and 71% (12 of 17) were able to walk.
Use of the traditional hip spica cast resulted in a significantly greater care burden for the family as measured with use of the Impact on Family Scale (43.3 for the traditional hip spica group compared with 35.6 for the walking hip spica group, p = 0.04).
Insurance-funded ambulance transportation was needed for 11 of the 26 patients treated with a traditional hip spica cast compared with none of the 19 patients treated with a walking hip spica cast (p = 0.001).

Conclusions

The walking hip spica cast and the traditional hip spica cast resulted in similar orthopaedic outcomes, and the walking hip spica cast resulted in a lower care burden for the family. Surgeons and families should be aware that use of a walking hip spica cast rather than a traditional hip spica cast may be associated with a greater likelihood that wedge adjustment of the cast will be necessary to treat fracture malalignment.

Supplemental

The Treatment of Low-Energy Femoral Shaft Fractures: A Prospective Study Comparing the “Walking Spica” with the Traditional Spica Cast

Flynn, Wells, et al.J Bone Joint Surg Am201154 citationsProspective cohort