Early versus late hip spica casting for paediatric femoral shaft fractures. Issue 2 (March 2019)

• Record Type: Journal Article
• Authors: Younis, Manaf H.; Mahmoud, Karim; Kawas, Alaa; Ibrahim, Talal
• Is Part Of: Journal of pediatric orthopedics. Volume 28:Issue 2(2019)
• Publication Date: 2019-03
• Subjects: casting -- children -- femur shaft -- fracture -- hip spica -- time; Pediatric orthopedics -- Periodicals; 618.927005
• DOI: 10.1097/BPB.0000000000000558
• Languages: English
• ISSNs: 1060-152X

Abstract

Abstract : The purpose of our study was to evaluate the effectiveness of treating paediatric femoral shaft fractures by early (<48 h) versus late (>48 h) hip spica casting. A retrospective review of 44 patients with 44 femoral shaft fractures treated by either early or late hip spica application with at least 9-month follow-up was undertaken. Both groups were treated on an inpatient basis. The late hip spica group had skin traction applied before the application of a hip spica. The outcome measures involved both clinical [Pediatric Outcomes Questionnaire (POQ) and Activities Scale for Kids (ASK)] and radiological outcomes. Complications were noted. A total of 44 patients with a mean age of 33 months (range: 7–66 months) were evaluated. Overall, 20 patients underwent early and 24 had late hip spica casting. At follow-up, the ASK was similar amongst the two groups (44.2 vs. 44.8, P =0.8). However, the POQ was better in the early hip spica casting group (24.7 vs. 28.9, P =0.01). Length of hospital stay and duration of immobilization in the hip spica were significantly shorter in the early group ( P <0.001). There were no differences in leg lengths, lateral distal femoral angles and medial proximal tibia angles between the fractured and nonfractured limbs in both groups. Early hip spica casting is a safe procedure for paediatric femoral shaft fractures and was associated with less time in hospital and hip spica with a better POQ score. However, early hip spica casting was associated with more hip spica changes and required wedging. At follow-up, radiological parameters were similar in both groups. Level of Evidence: III.