Young children with a fractured femur (thigh bone) can be treated in a number of different ways. Most involve casting of some sort. To prevent movement and allow the bone to heal, a spica cast is used most often. This type of cast starts at the waist and goes all the way down to the toes.
The spica cast may be single leg or double-leg. The single leg cast ends above the hip on the uninjured side. This type of cast leaves the uninjured leg free to move. The double leg cast immobilizes the injured leg from waist to toes and covers the other hip down to just above the knee. Not being able to bend at the hips (and knee) for four to six weeks presents some difficulties for families caring for young children.
In this study, orthopedic surgeons at The Johns Hopkins Hospital in Baltimore, Maryland compare results between single-leg and double-leg spica casting. The children in the study were all between the ages of two and six with a diaphyseal femoral fracture. The diaphyseal part is the shaft or middle long part of the bone. The hope was to provide an easier way to care for these children using a single-leg cast without compromising the results.
Treatment of diaphyseal femoral fractures with spica casting is considered “best practice” based on recommendations from the American Academy of Orthopaedic Surgeons (AAOS). Cast immobilization avoids surgery with anesthesia, scarring, and the possibility of complications.
Surgeons recognize that even casting has its downside. Skin problems can develop under the cast. Too much pressure can cause swelling causing a compartment syndrome. And, of course, caring for a child in such a bulky cast is no easy task. Transporting the child in the car seat or car, toileting, and lifting and carrying the child are some of the challenges the family members or caretakers face.
But the good news is that the benefits of a single-leg spica cast were very valuable to the families while still resulting in fracture healing. The parents or care givers took fewer days off from work to care for the child.
The single leg cast could be molded with enough hip and knee flexion (bend) to allow the child to sit in a special car seat. And the children with single-leg spica casts could sit in chairs more comfortably. Children in this type of cast could even walk a little bit.
The surgeons conducting this study summarized their recommendations by offering the following opinions: