Single-legged spica casts show benefits over double-legged casts for pediatric femoral fractures

BALTIMORE — A prospective, randomized controlled trial has found that single-legged spica casts for pediatric femur fractures perform as well as double-legged casts and might offer benefits for both parents and their injured children.

“Spica casting has been used since 1898, with the first spica cast being put on by Harvey Cushing,” Dirk Leu, MD said at the 2010 Annual Meeting of the Orthopaedic Trauma Association, here.

He noted that double-legged casting is the standard treatment for pediatric femur fractures, but that treatment can be troublesome for the families of the casted children.

Disruptive treatment

Dirk Leu

“We found that double-legged spica casting in pediatric patients can be significantly disruptive to the family in terms of time taking off work or school,” he said. “So, we determined that there is a need for improving the treatment for these children so that families can facilitate care for these patients more easily.”

The investigators developed a prospective, controlled and randomized study of children between 2 and 6 years old with diaphyseal femur fractures, who were casted in either single- or double-legged spica casts.

Following cast removal, patients were evaluated with the Activity Scale for Kids (ASK) and a custom survey of the parents to assess the ease of care and the function of the children during treatment.

The study enrolled 52 patients during a 3-year period. They were followed until the casts were removed. The average age of the children was similar between the two groups and the casts remained on for roughly the same amount of time, Leu said.

All healed

Radiographs were analyzed for angulation and shortening.

“Our results showed that patients treated with single-legged spica casts were significantly more able to fit into car seats, that their family members took significantly fewer days off from work and that their comfort sitting in a chair was increased,” Leu said.

According to Leu, they found that all the children healed successfully; that the average shortening was not significant and that there were no significant differences in angulation in the sagittal or coronal planes.

“There was significant difference in the ability to walk in the single-leg casted group,” he noted.

There was no difference in the two groups ASK results.

Reference:
Leu D, Gurkan E, Sargent C, et al. Spica casting in pediatric femur fractures: A prospective randomized controlled study on 1 leg versus 1.5 leg spica casts. Paper #62. Presented at the 2010 Annual Meeting of the Orthopaedic Trauma Association. Oct. 13-16, 2010. Baltimore.

I applaud you on getting level 1 evidence for single-legged spica casting for femur fractures. You included the foot in your casting … I think the first study you quoted by Dr. Epps that looked at single-legged casting did not include the foot. I think that everyone should recognize that you can get a compartmental syndrome in the leg of a child with a cast for a femur fracture, and another advantage of leaving the foot out is you can easier assess swelling and neurologic function.

— Steven L. Frick, MD
Orthopaedic Trauma Association moderator

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