Is Hip Spica an Obsolete Method for Paediatric Femur Fractures ? - A Retrospective Analysis of 58 Patients (original) (raw)
Related papers
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.
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 ...
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.
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, 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.
Canadian Journal of Surgery
Incidence of secondary interventions after early spica casting for diaphyseal femur fractures in young children Background: Children aged 6 months to 5 years with diaphyseal femur fractures are typically treated with spica casting, as recommended by the American Association of Orthopaedic Surgeons clinical practice guideline. We aimed to determine the incidence of secondary interventions after early spica casting for femur fractures in children aged 6 years or less. Methods: This was a retrospective cohort study of patients aged 6 years or less with diaphyseal femur fractures treated with early spica casting at a single Canadian tertiary care, level 1 trauma pediatric centre between January 2005 and May 2015. Results: A total of 246 patients were included (190 boys [77.2%] and 56 girls [22.8%] with a mean age of 2.28 yr [standard deviation (SD) 1.35 yr]). Nine patients (3.7%) required early secondary interventions (cast wedging in 8 and flexible intramedullary nail fixation in 1). At last follow-up, 51 patients (20.7%) had clinically measurable limb length discrepancy (LLD) (mean 9.4 mm [SD 3-25 mm]), and 1 patient (0.4%) had mild clinical valgus deformity. Older, heavier patients with initial fracture shortening of 20 mm or more had a higher likelihood of developing a clinically measurable LLD. No patient required surgical intervention after fracture union to correct acquired LLD or angular deformity. Conclusion: Early spica casting for diaphyseal femoral fractures in children aged 6 years or younger had a low rate of complications and return to the operating room, Although 21% of patients had a clinically measurable LLD at last follow-up, no patient required secondary intervention after fracture union to correct acquired LLD or angular deformity. These findings have relevance for the Canadian health care system, especially during the COVID-19 pandemic.
Orthopedic & muscular system, 2016
There are various methods of treatment of closed diaphyseal fractures of femur in children, but historically the vast majority of fractures of femur in children have been treated with hip spica casting alone or with initial traction followed by hip spica cast and each method has particular indications, contraindications and complications that must be considered in choosing the optimal treatment for a particular child and his/her fracture. Whatever the treatment method used we report a comparative study of thirty children aged from 6 months to ten years of age presenting with diaphyseal fractures of femur. Out of these thirty children, fifteen were treated with hip spica cast application and other fifteen children were treated with initial skin traction followed by hip spica cast. Hip spica cast has the additional advantages of being economical to the patients and the hospital services. It spares number of available beds in the hospital and is more convenient and comfortable for parents and children. Whereas initial traction followed by hip spica cast is better method of treatment in cases when there is a risk of excessive shortening. This study showed almost comparable results in the above mentioned two methods of treatment and final outcome in most of the cases was satisfactory.
Outcome of Fractures SOF in Children Treated with Early Hip Spica: A Prospective Study
Scholars Research Publisher , 2022
Background: In children, femoral shaft fractures are usually treated by initial performance and durability for 3 to 4 weeks, followed by an additional period of immobilization in a hip spica cast until union occurs. However, such treatment would involve prolonged hospital stays, thereby increasing the cost and occupancy of hospital beds. Early hip spica cast application of femoral shaft fractures in children is a valuable alternative to the traditional treatment method. It allows for a short hospital stay, thereby avoiding all the problems associated with prolonged hospitalization. Methods: This prospective study was conducted on 20 patients. Multicentered based non-randomized evaluations were performed in
Journal of Children's Orthopaedics, 2010
Flexible intramedullary nailing (FIN) is the gold standard treatment for femur fracture in school-aged children. It has been performed successfully in younger children, although Spica cast immobilisation (SCI) has been the most widely used strategy to date. Method A retrospective analysis was performed between two comparable groups of children aged 1-4 years with a femoral shaft fracture. Two University hospitals, each using specific treatment guidelines, participated in the study: SCI in Group I (Basel, Switzerland) and FIN in Group II (Lausanne, Switzerland). Results Group I included 19 children with a median age of 26 months (range 12-46 months). Median hospital stay was 1 day (range 0-5 days) and casts were retained for a median duration of 21 days (range 12-29 days). General anaesthesia was used in six children and sedation in four. Skin breakdown secondary to cast irritation occurred in two children (10.5%). The median follow-up was 114 months (range 37-171 months). No significant malunion was noted. Group II included 27 children with a median age of 38.4 months (range 18.7-46.7 months). Median hospital stay was 4 days (range 1-13 days). All children required general anaesthesia for insertion and removal of the nails.
Traction spica cast for femoral-shaft fractures in children
International orthopaedics, 2003
We treated 20 children for an isolated femoral shaft fracture using distal tibial traction incorporated into a spica cast with the knee in full extension. Patients were discharged from the hospital at a mean of 5.1 days following injury. All fractures healed, and there were four minor complications. At a mean follow-up of 35 (13-72) months, all patients were asymptomatic with normal function. All but one fracture healed in acceptable alignment, and there was no clinically significant leg-length discrepancy. The method is relatively simple to employ and may be advantageous in a setting of limited resources.