Traction spica cast for femoral-shaft fractures in children (original) (raw)
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Z H Sikder Women’s Medical College Journal, 2020
Femoral shaft fractures are among the commonest fracture of lower extremity in children and commonly require hospital admission. There are various modalities of treatments both operative and non-operative. The aim of treatment is to secure union, in good alignment with length restored and early rehabilitation. objective of this study was to compare the results of day 1 spica cast and skin traction followed by spica cast in the treatment of femoral shaft fractures in children (6 months to 10 years). A total of 64 patients with fracture shaft femur of either sex aged 6 months – 10 years with closed , isolated diaphyseal femur fracture were included in this study. Case with clinical evidence of infection, pathological fractures and multiple injuries including neurovascular injuries were excluded from the study. The patients were randomly assigned into two groups, Group -1 ( n-32) patients who underwent early spica application while Group -2 ( n-32) patients underwent skin traction in f...
International Journal of Research in Orthopaedics, 2020
Background: Femoral shaft fractures, though not very common, are of major concern for orthopedic surgeons. the management for infants and older children is generally universal but the young patients still offer a management dilemma.Methods: We present a prospective study conducted at a tertiary care hospital in India of 37 children between 1 year and 6 years to compare the two conservative methods most commonly used i.e. spica casting and traction application.Results: We found that though both the methods are similar in the time for union, shortening was better controlled with traction and angulation with spica casting. The frequency of other complications was also comparable.Conclusions: Both the methods give acceptable results and given the feasibility of such procedures in developing countries, both may be recommended. However, the choice thus depends on the surgeon treating the patient keeping in mind the drawbacks and limitations of each.
Hip Spica Casts in the Management of Femoral Shaft Fractures in Young Children
2019
Shaft fractures occur frequently in young children leading to hospital admission. Most of them are treated using closed non-operative methods. Rich blood supply of the shaft allows rapid healing and favorable outcome. Objective: To compare primary hip spica cast versus secondary hip spica cast in management of fracture shaft of femur in children less than 6 years of age in terms of frequency of limb length discrepancy.
Dynamic skeletal traction spica casts for paediatric femoral fractures in a resource-limited setting
International Orthopaedics, 2008
The objective of this study was to compare elastic intramedullary nailing (EIN) with dynamic skeletal traction spica casting (DSTSC) in terms of postoperative radiographic angulations, length of hospital stay, and cost in a resource-limited setting. We prospectively studied 51 children, five to twelve years of age, with femoral fractures treated with either EIN (n=26) or DSTSC (n=25). Children treated with EIN had significantly longer hospital stays (17± 8.0 days) than those treated with DSTSC (6.0±2.5 days). Financial constraints in acquiring supplies caused a significant increase in time from admission to surgery (EIN 9.5± 2.3 days; DSTSC 1.1±0.3 days), and cost was about 400% higher for EIN compared with DSTSC. At twelve weeks follow-up, all patients in both groups had acceptable radiographic angulations. In resource-limited healthcare settings, DSTSC is an effective alternative to EIN with comparable post-op radiographic angulations, decreased hospital stays, and lower cost. Résumé Le but de cette étude est de comparer l'enclouage par clou élastique intramédullaire (EIN) et la traction dynamique avec plâtre (DSTSC). Des examens post-opératoires ont été réalisés sur les radiographies mesurant l'angulation, la longueur de l'hospitalisation et son coût. Méthode: nous avons réalisé une étude prospective sur 51 enfants de 5 à 12 ans, présentant une fracture fémorale traitée soit par clou élastique intramédullaire (26 patients) soit par traitement orthopédique DSTSC (25 patients). Résultats, les patients traités par clou élastique ont eu une hospitalisation beaucoup plus longue (de 7 à±8 jours) que ceux traités orthopédiquement par le DSTSC (6±2,5 jours) avec des contraintes financières plus importantes et des durées de séjour entraînant un surcoût de 400% plus important pour le clou comparé au traitement orthopédique. A 12 semaines de suivi tous les patients ont eu un résultat radiographique tout à fait acceptable en termes d'angulation. En conclusion: en période de ressource limitée pour la santé, le traitement orthopédique est une alternative efficace face à l'enclouage par clou élastique intramédullaire notamment en ce qui concerne l'angulation post-opératoire, la diminution de la durée moyenne de séjour et la diminution des coûts.
2021
This prospective descriptive study aims to assess the importance of the immediate hip spica in a fracture of the femoral shaft in children at the Orthopedic Department of Liaqat University of Medica and Health science Jamshoro, Pakistan, for a one-year duration from June 2019 to June 2020. All children 1 to 5 years of age with femoral fractures who were admitted to the Orthopedic department within seven days of injury were included in the study. A total of 35 children, 24 (68.6%) boys and 11 (31.42%) girls, with a mean age of 3.8 years, were treated with an immediate hip spica cast. Their ages ranged from 1 to 5 years. The time of immobilization of the Spica cast ranged from 4 to 6 weeks (mean 5.4 weeks). In the second week, seven (22.85%) children had spica wetting, and breakage and reinforcement of spica was done, and 5 (14.28%) children had a spica wedging, and casting was applied to fix the angulation. No extension or hypertrophy was observed in the fractured limb. We concluded ...
2008
Objective: There is no consensus on treatment of closed femoral shaft fractures in children 6-12 years old .The aim of this study was to evaluate and compare the short term results of pediatric femoral shaft fractures at above ages with two different methods of treatment: skeletal traction followed by a hip spica cast and surgical treatment by intramedullary pin fixation and to determine which of these methods results in earlier union of fracture and independent ambulation of the patients. Methodology: This study was performed prospectively at two hospitals during a period of 32 months from 2003 through 2006. Sixty six children with closed fractures of the femoral shaft were treated and followed at least through the time of fracture healing, spica cast removal and onset of unprotected walking in two separate groups: (A) skeletal traction by 90 – 90 technique followed by spica cast (n=30), (B) open reduction and internal fixation with intramedullary pin and cast (n=36). The length of...
Journal of Orthopaedic Surgery and Research, 2013
Objective: The objective of this study was to analyze our experience in treating femoral shaft fractures with different strategies, focusing on the first year after injury when the choice of method would have the greatest impact. Methods: We reviewed the medical records of all children treated for femoral shaft fractures in our institution between 1997 and 2010. They were divided according to therapeutic approach: spica cast, skin traction, titanium elastic nail (TEN), external fixator, intramedullary medullary nail (IMN), and plating. Results: The 212 patients included 150 boys and 62 girls (M/F ratio 2.4:1, mean age 5 years, range 0-16). The postoperative radiographic results demonstrated solid union in all patients, with no malunions. Of the 151 children in the spica cast group, 10 required re-manipulation and casting due to loss of reduction with unaccepted angulation, 10 had contact dermatitis, and 2 had fever and pressure sores. All 21 elastic nail group children underwent re-operation to remove the hardware: 3 had soft tissue irritation at the insertion points, and 3 had leg length discrepancy (LLD). Of the 14 external fixation patients, 4 had LLD, 1 had a pin tract infection, and 1 had a fracture through a pinhole after a fall. There were no complications in the 12 IMN patients, the 3 plating patients, or the 11 skin traction patients. LLD rates in the spica group were 10.5% higher compared to those in the control group (other treatment modalities) (P = .03).
Paediatric femoral fractures treated by hip spica- Result of 42 patients
Hong Kong Journal of Orthopaedic Research, 2020
Background- For diaphyseal femur fracture, treatment options varies from conservative as hip spica or operative as nailing/plating.We analysed results of patients treated conservatively in a hip spica cast. Material and Methods- 42 patients, upto 5 years of age, with shaft femur fracture managed by hip spica cast were retrospectively analysed in terms of healing clinically and radiologically and complications, if any. Results- Fracture healed satisfactorily in all patients. Males were more affected and road side accident was most common etiology. Mean hospital stay was 3.5 days. Most common complication was skin breakage (33.3%) followed by cast soiling or breakage (14.3%) while shortening was seen in 2 patients and angulation in one patient. Conclusion- Despite newer and safer implants, hip spica remains safe and cost effective method for treatment of femur fracture in children.
International Journal of Research in Orthopaedics, 2016
Femoral-shaft fractures are among the most common fractures of the lower extremity in children, with an annual incidence of up to 1 per 5,000. 1,2 There are several different options for treating femoral-shaft fractures in children, including skeletal or skin traction, early or immediate application of a hip spica cast, pontoon spica, closed reduction and minimally invasive plate osteosynthesis, external fixation, plate fixation, and internal fixation with the insertion of intramedullary nails. 3,4 Selecting the management strategy is dependent on factors such as the presence of other associated injuries or multiple trauma, fracture properties, age, and socioeconomic factors. Because of its clinical effectiveness and low rate of complications, elastic stable intramedullary nailing for fractures of long bones in the skeletally immature patient (e.g. children) has gained widespread popularity. Titanium elastic nailing (TEN) is commonly used to stabilize femoral fractures in schoolaged children, We tried to compare the end results of both modalities of the treatment of diaphyseal fracture femur and found the operative treatment stands far superior to age old traditional cast treatment. METHODS Prospective study was conducted from March 2014 to February 2015. Children with closed femoral shaft fracture, age ranging between 6 to 16 year were included ABSTRACT Background: There is no consensus on treatment of closed femoral-shaft fractures in children. We compared hip spica cast with titanium elastic nailing (TEN) in the treatment of femoral-shaft fractures in children. Methods: Study was conducted at SMS Medical College, Jaipur (Rajasthan). Out of 90 Patients of diaphyseal fracture femur, 45were treated conservatively by spica cast and 45 were treated with TEN. Follow up done regularly up to twelve months of injury with taking into account, various parameters. Results: All diaphyseal fractures of femur healed, whether treated conservatively by spica cast or treated operatively with TEN. The time of union and weight bearing was less in operative group as comparative to spica cast group. Ten patients (22.22%) in spica group compared to three patients (6.66%) in operative group had malunion and two patients (4.4%) in spica group compared none in operative group had delayed union. Conclusions: Results of TEN turned out to be far superior to traction and spica cast treatment in paediatric femoral fractures. Rate of complications was far low with operative than conservative Treatment.
European Journal of Radiology, 2003
Twenty-eight children with femoral shaft fractures, treated with early spica cast, were evaluated with computed tomography (CT), for their femoral shaft rotational deformities. The femoral torsion angles were measured on both sides. If the torsion angle of the fractured side was more than the other side, it was considered as an internal rotational deformity and if it was less, it was considered as an external rotational deformity. Internal rotational deformities were detected in nine cases and external rotational deformities were detected in 17 cases. Rotational deformity was not observed in two cases. Four cases, with a rotational deformity more than 108, were corrected with a gypsotomy through the level of the fracture. We concluded that a rotational deformity, which is an important complication in conservative treatment of the femoral shaft fractures in children, can be determined exactly with CT and corrections on the spica cast can be made with a gypsotomy.