1318 Skin Related Complications in Children Treated with Hip Spica Casts for Femur Fractures

Abstract

Purpose: Document the incidence of skin relatedcomplications in children treated with a spica castfor femur fractures and determine associated castchange charges. Background: Closed reduction and spica castingremains the treatment of choice for femur fracturesin children < 6 years. Caring for a child in a hip spicacast poses challenges for caregivers includingkeeping the cast clean. Skin breakdown caused bymoisture causes discomfort and the need for repeatcasting. Skin related complications are financiallycostly to both the family and the healthcare system. The incidence of skin related complications is poorlydocumented. Methods: A retrospective chart review (2003-2009)was conducted on children who sustained a femurfracture and who were treated with spica casting. Skin related complications were identified and costsassociated with a cast change were calculated. Results: The study included 300 cast placements. Two hundred and twenty three completed spica casttreatment without any reported skin complications. Seventy seven of the children had skin problemswith 24 of these requiring a cast change in the OR,34 requiring early bi-valving and lining of the castand, and 19 requiring additional skin care. Themedian costs for a cast change was $14,731.00 Conclusion: Spica cast treatment is associatedwith numerous skin related problems and additionalcosts. These data will serve as baseline dataof complications secondary to spica casting forfemur fractures and are benchmarks for qualityimprovement programs as well as alternativetreatment options such as Gortex cast padding orinternal fixation.