SHORTENING IN FEMORAL-SHAFT FRACTURES IN CHILDREN TREATED WITH SPICA CAST

Early spica cast treatment is one method used for children's femoral s haft fractures; it is increasingly advocated as treatment that allows early hospital discharge, The outcome of early spica cast treatment in 100 children, ages 2 to 10 years, with uncomplicated and isolated clo sed femoral shaft fractures treated at Johns Hopkins Hospital between October 1957 and March 1994 were analyzed. The objective was to identi fy those children who can be treated safely and dependably with early spica casting without excessive shortening of the fracture fragments. Eighty-one (81%) children had an acceptable outcome and 19 (19%) had a n unacceptable outcome by the definition of more than 25 mm of fractur e fragment overlap after clinical healing, A new clinical test, the te lescope test, was statistically significant for correlation with spica cast outcome, Age, gender, fracture, location, mechanism of injury, f racture type, and resting radiograph of fracture fragment overlap were not statistically significant. The telescope test had a sensitivity o f 80% and a specificity of 85% for predicting outcome. The relative ri sk for failure of spica cast treatment with a positive telescope test was 20.4 (95% confidence limits = 2.7-225.1). Children 2 to 10 years o f age with uncomplicated femoral shaft fractures and a negative telesc ope test can be treated appropriately in most cases with early applica tion of a spica cast.