Twenty-one children younger than 2 years with a fractured femur were evalua
ted retrospectively to determine limb overgrowth, efficacy, and outcome aft
er treatment with immediate spica casting. All children had spica casts pla
ced without general anesthesia within 24 hours of admission. Followup avera
ged 51 months (range, 24-110 months). Average shortening in the spica cast
at initial application was 0.5 cm (range, 0-1.8 cm), The average length of
hospitalization was 2.2 days. Three patients went home the same day, and se
ven were discharged after a single overnight stay in the hospital. No patie
nts underwent closed manipulation or a cast change for malalignment of the
fracture, Child abuse was identified as the mechanism of injury in eight of
12 (67 %) children younger than 1 year of age and in only one of nine (11
%) children between 1 and 2 years of age. Leg lengths were determined by me
asurement with tape and graduated blocks.;it followup, the average limb len
gth inequality was 0 cm, with an average net growth of 0.5 cm (range, -0.5-
1.8 cm). Only one child had a limb length inequality of more than 1 cm as m
easured with tape (20 months of age), and no child had a limb length inequa
lity of more than 1 cm as measured with blocks. No child or parent reported
any residual pain, limp, or limitation of activity. The results of this st
udy suggest that overgrowth does occur in children younger than 2 years. Ad
ditionally, immediate spica casting with early discharge to home is associa
ted with few complications, no functional limitations, and minimal limb len
gth inequality.