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Satisfactory results seen with one-leg casting of pediatric femur fractures
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NEW ORLEANS — Treating pediatric femur fractures with one-leg spica casts is effective and can lead to easier patient care than treatment with 1.5-leg spica casts, according to the results of a prospective, randomized controlled study presented here.
“One and a half- and one-leg spica both offer satisfactory alignment,” David Leu, MD, said. “Children with one- leg spica were more likely to fit into car seats as well as [had] fewer days taken off of work by family members. [It] results in better comfort in chairs, and there was a trend towards more independent walking.” He presented the findings at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons.
Level 1 study
Leu and his colleagues studied 51 pediatric patients between the ages of 2 and 6 years who had diaphyseal femur fractures and underwent either one- or 1.5-leg spica casting. The one-leg cast group included 23 patients and the 1.5-leg cast group included 28 patients. Both groups had their casts removed at an average of 44 days.
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The investigators found that all of the patients healed. They also discovered no significant differences between the groups regarding the average limb shortening, crawling and independent movement. However, they found a trend toward more independent walking in the one-leg casted group.
Patient care
In addition, they discovered that 71% of patients in the one-leg cast group fit into car seats compared to 36% in the 1.5-leg cast group. They also found that family members of the one-leg casted patients took off an average of 10 days from work to care for the patients compared to 20 days for the family members of the 1.5-leg casted patients. The study also revealed two complications. One patient in the 1.5-leg group underwent plate fixation for unacceptable shortening, and one patient in the one-leg group had a re-reduction and cast replacement.
- Reference:
Leu D, Erkula G, Sargent MC, et al. Pediatric femur fractures: Prospective, randomized controlled study: One versus 1 & 1/2 leg spica casts. Paper #621. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 9-13. New Orleans.
I think that it was a nicely done study, well-designed [and with a] good methodology. The findings, according to the authors and in my opinion, probably do not radically change our care, but I think they help us conclude that the single leg spica is probably equivalent or adequate to the 1.5 leg spica.
-Michael T. Archdeacon, MD
Session moderator
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