Immediate Incorporated Hip Spica Casting in Pediatric Femoral Fractures

Akşahin, Ertuğrul; Çelebi, Levent; Yüksel, Halil Yalçın; Hapa, Onur; Muratli, Hasan Hilmi; Aktekin, Cem Nuri; Biçimoğlu, Ali

doi:10.1097/bpo.0b013e3181924349

Cited by 13 publications

(14 citation statements)

References 22 publications

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“…Pin tract infection was reported in patients treated with incorporated immediate spica casting; however, no deep infection or osteomyelitis was observed [12,16,17]. No pin tract infections were seen in our cases.…”

Section: Discussionmentioning

confidence: 52%

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Treatment of Femur Fractures in Preschool Children with Double Pin Technique: Immediate Incorporated Hip Spica Casting by Two K-Wires

2013

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The immediate hip spica casting is a popular treatment method for femoral fractures in the pediatric age group. Femoral shortening is the unacceptable result for the treatment. In this technique, we tried to describe the immediate spica casting technique pinning with double K-wire in preschool children and evaluate the results with this method. Sixteen patients (ten boys and six girls) are treated with this technique. Patients were treated under general anesthesia in the operating room. K-wire was introduced in the supracondylar area of the femur passing from the lateral to the medial side through both cortexes, and removed from the skin in the medial section. A second K-wire was introduced through the lateral side of the proximal fragment. While an assistant was applying traction to the pin to maintain the reduction, the lower extremity was put in a spica cast on the fractured side, while the knee joint on the other side was excluded from the spica casting process. The angulation after hip spica cast applied was 9.1°(range 7°-12°) on the frontal plane and 8.9°(range 5°-17°) on the sagittal plane. After spica cast removal, it was 8.5°(range 5°-13°) on the frontal plane and 9°(range 5°-17°) on the sagittal plane. No significant difference was found. The final mean leg length discrepancy was 4.8 mm (range 0-10 mm) at the time of cast removal. This technique may be effective for femoral diaphyseal fractures in preschool children to combine the spirits of external fixation with hip spica casting in one construct in order to correct angular deformities and length discrepancies.

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Section: Discussionmentioning

confidence: 52%

“…In unsuccessful cases, skeletal traction or surgical methods are used [3,8,9]. Such repeated interventions increase the treatment costs [16], and both the patient and healthcare professionals are exposed to radiation due to frequent use of Xrays or fluoroscopy. This is a disadvantage of the technique [3].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Femur Fractures in Preschool Children with Double Pin Technique: Immediate Incorporated Hip Spica Casting by Two K-Wires

2013

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“…Another parameter to be taken into account and on which there is no consensus is initial fracture shortening. In the opinion of some authors, even fractures initially presenting with >2.5 cm shortening can be successfully treated conservatively,14 but according to others15 the risk of limb shortening is 20.4 times as high as in cases presenting >30 mm overlap at the fracture site.…”

Section: Discussionmentioning

confidence: 99%

Diaphyseal femoral fractures below the age of six years: Results of plaster application and long term followup

Catena

Senes

Riganti

et al. 2014

IJOO

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Background:In children less than 6 years, the treatment of femoral shaft fracture is often non surgical, using closed reduction and casting. The literature reports many experience about this type of trauma but none of these has a long term followup. We present a retrospective study on a group of femoral diaphyseal fractures treated nonsurgically in children up to 6 years of age, with a minimum of 10 year followup.Materials and Methods:48 cases (36 males/12 females) with femoral diaphyseal fractures treated between January 1988 and December 1998 were reviewed. Patients with fractures due to obstetrical trauma and pathologic fractures were excluded. The mean age of the patients was 3.3 ± 1.1 years (range 5 months-6 years). Right side was involved in 21 cases (44%), and left side in 27 cases (56%). In 34 cases (71%), closed reduction was performed and hip spica was applied with the hip and knee flexed to 45°. In 8 cases (17%), skeletal traction was applied to perform fracture reduction and the traction pin was embedded in plaster while in the remaining 6 cases (12%), the Delitala pressure apparatus was applied after casting.Results:All fractures healed in our study. There were no complications (infection or vascular nervous issues, axial deviations, consolidation delays, or pseudoarthrosis). In 13 cases (27%), followup examinations showed mean lengthening of 1.3 ± 0.75 (range 0.5-2.5 cm) of the fractured lower limb. All these patients were treated with skin traction before treatment and presented with 2.08 ± 0.28 cm mean initial femoral shortening. In 1 case (2%) with 2.5 cm lengthening, epiphysiodesis of the ipsilateral knee was performed. No patients showed prolonged difficulty with gait disorders.Conclusion:On the basis of our results conservative treatment of femoral shaft fractures in children can be considered less invasive and safe procedure.

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“…9,10,[23][24][25][26][27] Traditionally, application of a hip spica cast to treat an isolated femur shaft fracture involves 2-leg application, non-weight-bearing, and 6 to 8 weeks of treatment. 5,6 There are differing opinions on several treatment aspects, which include single-leg hip spica (SLHS) casting versus double-leg hip spica (DLHS) casting, weightbearing versus non-weight-bearing, and duration of treatment.…”

mentioning

confidence: 99%

“…4 After the age of 6 months and up to 5 years old, the standard treatment is a hip spica cast. [5][6][7] Some surgeons use skin or skeletal traction [8][9][10] or external fixators 11 either alone or in conjunction with hip spica casting. Over age 5, surgical treatments are more commonly used, including flexible titanium elastic nails, [11][12][13][14] submuscular bridge plates, 15,16 and eventually as the child gets closer to skeletal maturity, lateral entry intramedullary nails.…”

mentioning

confidence: 99%

Four Weeks in a Single-Leg Weight-Bearing Hip Spica Cast is Sufficient Treatment for Isolated Femoral Shaft Fractures in Children Aged 1 to 3 Years

Jaafar

Sobh

Legakis³

et al. 2016

Journal of Pediatric Orthopaedics

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Immediate Incorporated Hip Spica Casting in Pediatric Femoral Fractures

Cited by 13 publications

References 22 publications

Treatment of Femur Fractures in Preschool Children with Double Pin Technique: Immediate Incorporated Hip Spica Casting by Two K-Wires

Treatment of Femur Fractures in Preschool Children with Double Pin Technique: Immediate Incorporated Hip Spica Casting by Two K-Wires

Diaphyseal femoral fractures below the age of six years: Results of plaster application and long term followup

Four Weeks in a Single-Leg Weight-Bearing Hip Spica Cast is Sufficient Treatment for Isolated Femoral Shaft Fractures in Children Aged 1 to 3 Years

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