ASSESSMENT OF THE OUTCOME OF EARLY VERSUS DELAYED SPICA CAST IN THE TREATMENT OF CLOSED FEMORAL SHAFT FRACTURE IN CHILDREN
Hamid A Jaff
MB,ChB, DM, FICMS, Orthopedic Surgeon, College of Medicine, University of Sulaimaniyah, IRAQ.
This study aimed to assess the results of early versus late spica cast in the treatment of femoral shaft fracture in children.
This is a descriptive study performed at Al-Sulaimaniya Teaching Hospital during the period between June 2009 and October 2010.
Twenty eight patients with a mean age of five years ranged (2-8 years) with closed isolated femoral shaft fractures were included in this study. They were four females and twenty four males. Fifteen patients had left sided fractures while right sided fractures were in thirteen patients. Patients having compound fractures and those with associated injuries were excluded from the study.
Ten patients were treated by skin traction for about 2-3 weeks then hip spica cast was applied. The other 18 patients treated by early spica within 2-5 days. All patients were followed for a period of about 4 months after removal of spica cast.
The study reveals that boys are affected more than girls. The causes of the fracture in this study were 15 cases (53.6%) fall from height; 8 cases (28.6 %) road traffic accident and lastly 5 cases (17.9%) for other causes like direct trauma.
Average duration of skin traction in delayed Spica cast group was 2-3 weeks.
Immediate complications after removal of the spica; patients treated with early spica were 3 cases for side way angulation, 1 case for shortening, while for anterior angulation 1 case. Patients treated with delayed spica following skin traction complicated by anterior angulation was 1 case and side way angulation was 1 case while no case of shortening reported. The patients considered here to have a shortening or angulation are only those having a deformity of more than accepted limits (20 mm shortening, 15 degrees side way angulation and 20 degrees for anterior angulation), but after 10 months of follow up for all of the patients, most of the initially observed complications were corrected to the accepted limits. The shortening which was reported initially overcomed by overgrowth and only 0.8 cm length discrepancy was there. For both anterior and side way angulation, they were within the accepted limits.
In early spica, the hospitalization ranged from 2-5 days; while in delayed spica, the hospitalization time ranged from 16-23 days.
It is concluded that little significant difference in late outcome between early and delayed spica cast application regarding the complications of treatment and functional outcome, but early spica decreased the hospitalization time and the cost of treatment significantly.