SPICA CAST TREATMENT OF FEMORAL-SHAFT FRACTURES IN CHILDREN - THE PROGNOSTIC VALUE OF THE MECHANISM OF INJURY

We reviewed the data on 47 closed femoral shaft fractures in 46 childr en 10 years of age or less treated by early closed reduction and spica cast immobilization from 1980 through 1988. These children were follo wed at least through the time of fracture union, spica cast removal, a nd onset of unprotected weight-bearing. Treatment was defined as being primarily by spica cast immobilization if less than 7 days of skin tr action preceded closed reduction and cast application. The mean age at injury was 4.4 years (range, 0.2-9.9 years). Mechanisms of injury wer e identified and segregated into those involving high-energy and low-e nergy trauma. Twelve of 23 fractures (52%) caused by high energy requi red at least one repeat closed reduction or other treatment to correct excessive shortening or angulation that occurred following the initia l reduction. Four children required prolonged skeletal traction before reapplication of a spica cast. In contrast, only 2 of 24 fractures (8 %) caused by low-energy trauma required repeat closed reduction and no ne required skeletal traction. Whereas the mean age of the children su staining high-energy trauma (6.1 years) was higher than that of childr en in the low-energy trauma group (2.9 years), 7 of 12 fractures cause d by high energy that required repeat reduction occurred in children 7 years of age or less. Femoral shaft fractures in children caused by h igh energy are more likely to become displaced following closed reduct ion and early spica cast immobilization than fractures caused by low e nergy. These children require careful radiographic monitoring followin g this type of treatment to assess fracture alignment.