A PROSPECTIVE-STUDY OF EARLY SPICA CASTING OUTCOMES IN THE TREATMENT OF FEMORAL-SHAFT FRACTURES IN CHILDREN

We analyzed the early spica casting outcomes of 50 children age 2 to 1 0 years with uncomplicated femoral shaft fractures treated at Johns Ho pkins Hospital between October 1987 and October 1990. Our objective wa s to develop criteria for the prospective identification of patients w ho can be safely and dependably treated with early spica casting witho ut excessive shortening of the fracture fragments. Forty-one (82%) chi ldren had an acceptable outcome and nine (18%) had an unacceptable out come according to our definition of >25 mm of fracture fragment overla p at 3 to 4 weeks follow-up. A new clinical test, the telescope test, was statistically significant (p < 0.001) for association with spica c asting outcome. Age, sex, fracture location, mechanism of injury, frac ture type, and resting roentgenogram fracture fragment overlap were no t statistically significant (p > 0.10). The telescope test had a sensi tivity of 78%, a specificity of 85%, and a negative predictive value o f 95% for predicting spica casting outcome. The relative risk of faili ng spica casting after a positive telescope test was 20.4 (95% CI, 2.7 4-225.10). We conclude that children 2 to 10 years of age with uncompl icated femoral shaft fractures and a negative telescope test can be sa fely treated with early spica casting and have a 95% chance of having a successful outcome with this treatment.