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Traction and spica casting effective for children with closed femoral shaft fractures
No children experienced malunion or nonunion, and none developed a significant residual limb-length discrepancy at final follow-up.
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Managing closed femoral shaft fractures in children using skin traction and spica casting can result in good outcomes and avoids complications associated with surgical fixation, such as infection, necrosis and implant failure, according to a study by researchers in Singapore.
Dave Lee Yee Han, MD, and colleagues at the Kandang Kerbau Womens' and Childrens' Hospital, reviewed outcomes for 63 children treated conservatively for closed, isolated femoral shaft fractures. Patients averaged 5 years of age, ranging from 1 month to 15 years.
They published their results in the Journal of Orthopaedic Surgery.
In all cases, the child's injured limb was placed in skin traction shortly after hospital admission. Gallows traction was used for children who weighed less than 10 kg, or who were younger than 2 years old. Russell's traction was used for children who weighed more than 10 kg, or who were 2 years of age or older, according to the study.
Once the child showed signs of fracture consolidation, which were confirmed by the absence of tenderness, surgeons applied a one-and-a-half hip spica cast with the child under general anaesthesia.
Children were kept in traction for an average of 9 days, ranging from 2 to 15 days depending on age. Casting was maintained for an average of 5 weeks, ranging from 2 to 8 weeks, and bony union occurred after an average of 6 weeks, ranging from 3 to 12 weeks, according to the study.
All children had at least 6 months follow-up. At final follow-up, 14 children (22%) had a limb-length discrepancy, but none had a discrepancy over 1.5 cm or had a "short-legged" gait, the authors wrote.
"There were no instances of malunion, nonunion, significant residual limb-length discrepancy or rotational deformities," the authors reported, also noting that no child required cast removal due to loss of reduction.
For more information:
- Lee YHD, Lim KBL, Gao GX, et al. Traction and spica casting for closed femoral shaft fractures in children. J Ortho Surg (Hong Kong). 2007;15:37-40.