Systematic review of spica casting for the treatment of paediatric diaphyseal femur fractures

Abstract

PurposePaediatric femur fractures are commonly encountered and often successfully managed with spica casting. Despite spica casting’s long history there is little formal guidance for optimal outcomes and no consolidation of existing literature. The purpose of this study is to review the available literature regarding the use of spica casting for the management of paediatric diaphyseal femur fractures.MethodsThe PubMed database was queried for all research articles including the phrase “spica”. A total of 788 abstracts were reviewed for relevance to the current study. Data was extracted from all available research studies which specified tolerance for fracture angulation or shortening in the cast. Additionally, all articles describing alternative materials, methods for spica application, and complications of spica casting were reviewed.ResultsIn all, 106 articles were found relevant to the management of diaphyseal femur fractures in the paediatric population. The aggregated, accepted fracture shortening decreased from 16 mm to 18 mm before age ten years to 12 mm to 14 mm after puberty. Aggregated, accepted angulation decreased from 14° to 16° varus/valgus and 18° to 22° pro/recurvatum before age two years, to 6° to 8° and 10° to 12° by puberty, respectively. The overall reported complication rate was 19.6%, with the most common complication being skin compromise in 8.2% of patients, followed by unacceptable angulation at the fracture site in 4.2% of patients and excessive limb shortening in 1.9% of patients.ConclusionThis article reviews the available spica casting literature and compiles the available data. Spica casting offers a safe, effective means for definitive management of paediatric diaphyseal femur fractures. Future research identifying the rate and pattern of remodelling as it relates to angulation and shortening at various patient ages, particularly beyond the aforementioned norms, would be valuable to identify true biological tolerances versus accepted expert opinion.Level of evidence Level IIReview of level II evidence

Epidemiology and Associated Injuries in Paediatric Femoral Shaft Fractures Treated at a Limited Resource Zonal Referral Hospital in Northern Tanzania

“…Sports related falls were the most common mechanism of sustaining a femur fracture in these other studies, while our study saw a higher incidence of RTI with pedestrian versus MCA (17.3%). 16,20 Fractures resulting from RTIs had an increased risk of having an associated injury that is similar to other studies in the literature. 2,17 RTI also increased the risk of Waddell's triad, which was 3 (8%) of those with associated injuries in this study, similar to that seen in Nigeria (8.7%) but signi cantly lower that seen in the USA (25.5%).…”

Treatment of closed femoral shaft fractures in children aged 2–10 years: a systematic review and meta-analysis

“…Skin traction carries the risk of pressure sores, while skeletal traction can lead to bone damage [33]. Other complications for spica casting Nascimento [20] n = 30 3 (10%) 1 (3.3%) 2 (6.7%) Shemshaki [16] n = 23 3 (13%) 0 (0%) 3 (13%) Hsu [18] n = 25 2 (8%) 2 (8%) 0 (0%) Mehdinasab [15] n = 30 7 (23.3%) 4 (13.3%) 3 (10%) Flynn [19] n = 35 12 (34%) 6 (17%) 6 (17%) Song [21] n = 24 2 (8,3%) 2 (8.3%) 0 (0%) Buechsensuetz [22] n = 29 10 (34%) 10 (34%) 3 (10%) Younis et al [28] n = 20 4 (16.6%) 4 (16.6%) 0 (0%) D'Ollonne [26] n = 14 3 (21.4%) 2 (14.3%) 1 (7.1%) Yandow [27] n = 55 5 (9.1%) 3 (5.5%) 2 (3.6%) Curtis [24] n = 21 10 (48%) 8 (38%) 2 (10%) Henderson [25] n Nascimento [20] n = 30 3 (10%) 2 (6.7%) 1 (3.3%) Shemshaki [16] n = 23 3 (13%) 0 (0%) 3 (13%) Hsu [18] n = 26 3 (11.5%) 3 (11.5%) 0 (0%) Mehdinasab [15] n = 36 6 (16.7%) 6 (16.7%) 0 (0%) Flynn [19] n = 48 10 (21%) 6 (12.5%) 4 (8.3%) Song [21] n = 27 4 (14.8%) 1 (3.7%) 3 (11.1%) Buechsensuetz [22] n = 42 9 (22%) 7 (17%) 2 (5%) Ramo [13] n = 104 17 (16.3%) 9 (8.7%) 8 (7.7%) Ruhallah [7] n = 25 2 (8%) 2 (8%) 0 (0%) Assaghir [11] n = 52 10 (19%) 9 (17%) 1 (2%) Jauquier [9] n = 27 3 (11%) 2 (7.4%) [7] n = 25 4 (17%) 4 (17%) 0 (0%) Assaghir [11] n = 52 20 (38%) 20 (38%) 0 (0%) Jauquier [9] n = 19 2 (10.5%) 2 (10.5%) 0 (0%) Younis et al 2019 [28] n = 24 6 (30%) 6 (30%) 0 (0%) D'Ollonne [26] n = 21 3 (14.3%) 3 (14.3%) 0 (0%) Yandow [27] n = 33 1 (3.0%) 1 (3%) 0 (0%) Curtis [24] n include compartment syndrome and superior mesenteric artery syndrome [34,35]. Intramedullary nailing comes with general risks related to anesthesia and surgery risks like wound infection…”

Pediatrik Femur Kırıklarında İnkorpore Pelvipedal Alçılama Sonrası Rezidüel Deformite Sonuçları

“…Bu çalışmada pediatrik femur cisim kırıklarında erken inkorperepelvipedal alçılama sonrası rezidüel deformite varlığı değerlendirildi ve ön-arka ve yan planda kabul edilebilir bir açılanma oluşturduğu ancak klinik olarak tespit edilebilir bir rotasyonun olmadığı saptandı.Pelvipedal alçılama ya-tış süresinin kısa, maliyetsiz ve güvenli olması sebebiyle aşırı ödemi olmayan küçük çocukların tedavisinde önerilmektedir. Bununla birlikte kısalık ve açılanma gibi rezidüeldeformitelerin oluşması bu tedavideki önemli bir sorundur ve %6,1 oranında görüldüğü bildirilmiştir (18). Literatürde bu sorunun etkilerini azaltmak için 90-90 alçılama, 4-köşe alçı moldu, distalmetafizielpin ile inkorporasyon ve ponton tekniği önerilmiştir (15).…”