The treatment of pediatric femur fractures with early 90-90 Spica casting

Twenty-three consecutive children younger than 6 years with a closed femora l shaft fracture stemming from low-energy trauma were treated with an early spica cast. With the patient under general anesthesia, a fiberglass cast w as applied in sections. A short-leg cast was applied first, and then the pa tient was placed on the spica table. The hip and knee were flexed to 90 deg rees, and traction was applied to the injured limb via the short-leg cast w hile the cast was completed. The popliteal fossa was well padded, and a val gus mold was placed at the fracture site. The average number of days in the spica cast was 42 (range, 18-57 days). Average shortening of the fracture at the time of cast removal was 1.0 cm (range, 0.1-2.1 cm). Final patient e xaminations were performed 18-24 months after the fracture. Overgrowth aver aged 1.1 cm in the femur (range, 0.5-1.9 cm) and 0.4 cm (0-0.7 cm) in the t ibia. Limb lengths in each patient were within 1 cm of the contralateral li mb when measured by scanogram and by blocks. The success of early spica cas t treatment in this series can be attributed to strict patient selection an d meticulous cast application.