Bashir Ahmed Soomro, Nand Lal Kella.
Femoral shaft fractures in children treated by early spica cast.
J Surg Pak Jan ;13(3):103-7.

Objective: To find out the advantages of early spica cast as a treatment for isolated, uncomplicated femoral shaft fracture in children. Study design: Descriptive study Place and Duration of study: Department of Paediatric Surgery, National Institute of Child Health Karachi, for one year period. Patients and Methods: All patients under the age of 12 years, who presented during the study period with femoral shaft fracture were included in the study. Patients having compound fractures and those with associated injuries were excluded. All patients had radiological evaluation of the injury. They were prepared for spica cast under general anesthesia. Following recovery check x rays were taken to assess the reduction. Follow up done in outpatient clinic at weekly intervals for initial 3 weeks and then at longer intervals. Results: A total of 30 children with femoral fractures were treated with early spica cast. Age ranged from 2 year to 11 years. Male to female ratio was 2.75:1. Majority of children were under 5 years (n 20). In most of the children spica cast was applied on the day of presentation within few hours and were sent home on the same day. Twenty one children were followed till removal of spica cast. Period of immobilization in spica cast ranged from 4 weeks to 7 weeks with average of 5.73 weeks. Common problems related to spica cast were soakage and breakage of spica which occurred in 9(42.85%) children. At time of cast removal shortening ranged from 0.5cm to 2.5 cm in 15 out of 21 (71.42%) children. Angulation was found in 3/21 (14.28%) children. It ranged from 15 degree to 30 degree in anterior and 10 degree to 20 degree lateral position. Three children were followed for longer period. A 3 year old girl presented at 6 months with 2 cm of lengthening of fractured limb. Three children had equal limbs at one year after injury while a five year boy had 0.5 cm shortening of limb. Conclusions: Early spica cast is simple, effective and definite method of treatment with minmal complications and acceptable results in paediatric age group. It allows rapid return of child to family environment, thus avoiding prolonged separation from parents.

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