Immediate hip spica casting for femur fractures in pediatric patients : A review of 175 patients

Immediate closed reduction and application of a well-molded hip spica cast is a safe and effective treatment option for closed, isolated femur fractur es in children who weigh between 10 and 100 pounds. Between 1988 and 1996, 190 immediate hip spica casts were placed on children with isolated femoral shaft fractures who weighed between 10 and 100 pounds. Fifteen patients we re lost to followup leaving 175 children who were evaluated and followed up for at least 2 years after the hip spica cast was removed (range 2-10 year s). The femur fractures were reduced closed and placed in a 1 1/2 hip spica cast in the emergency room with the patient under conscious sedation or in the operating room with the patient under general anesthesia. All of the c hildren returned home within 24 hours of the procedure. All 175 femur fract ures united within 8 weeks. The only complication was a refracture in a 25 pound child who fell 1 week after the cast was removed. No significant resi dual angular deformities were present in any of the children at last follow up. None of the children required external shoe lifts, epiphysiodesis, anti biotics, irrigation and debridements, or limb lengthening procedures for le g length inequalities. The authors think that immediate closed reduction an d placement of a well-molded hip spica cast is a safe and reliable treatmen t option for isolated, closed femur fractures in children from birth to 10 years of age who weigh less than 80 pounds.