Abstract
Introduction:Hip spica casting is a standard treatment for children with femur fractures. This study compares the outcomes of spica cast application, in terms of quality of fracture reduction and hospital charges when performed in operating theatre versus outpatient clinics at a local institution.Materials and Methods:A total of 93 paediatric patients, aged between 2 months to 8 years, who underwent spica casting for an isolated femur fracture between January 2008 and March 2019, were identified retrospectively. They were separated into inpatient or outpatient cohort based on the location of spica cast application. Five patients with metaphyseal fractures and four with un-displaced fractures were excluded. There were 13 and 71 patients in the outpatient and inpatient cohort respectively who underwent spica casting for their diaphyseal and displaced femur fractures. Variables between cohorts were compared.Results:There were no significant differences in gender, fracture pattern, and mechanism of injury between cohorts. Spica casting as inpatients delayed the time from assessment to casting (23.55 ± 29.67h vs. 6.75 ± 4.27h, p<0.05), increased average hospital stay (41.2 ± 31.1h vs. 19.2 ± 15.0h, p<0.05) and average hospital charges (US$1857.14 vs US$775.49, p<0.05). Excluding the un-displaced fractures, there were no significant differences in the period of cast immobilisation and median follow-up length. Both cohorts had a similar proportion of unacceptable reduction and revision casting rate.Conclusion:Both cohorts presented similar spica casting outcomes of fracture reduction and follow-up period. With spica cast application in operating theatre reporting higher hospital charges and prolonged hospital stay, the outpatient clinic should always be considered for hip spica application.
Highlights
Hip spica casting is a standard treatment for children with femur fractures
Inpatients were treated in the operating theatre (OT) while outpatients were treated in the emergency department (ED) or clinic plaster room (PR)
Our results demonstrate approximately twice the time to spica application, length of hospital stay, and initial hospitalisation bill was required for inpatients who underwent spica cast application in OT compared to those done in the ED or PR
Summary
Hip spica casting is a standard treatment for children with femur fractures. This study compares the outcomes of spica cast application, in terms of quality of fracture reduction and hospital charges when performed in operating theatre versus outpatient clinics at a local institution. Materials and Methods: A total of 93 paediatric patients, aged between 2 months to 8 years, who underwent spica casting for an isolated femur fracture between January 2008 and March 2019, were identified retrospectively They were separated into inpatient or outpatient cohort based on the location of spica cast application. Excluding the un-displaced fractures, there were no significant differences in the period of cast immobilisation and median follow-up length Both cohorts had a similar proportion of unacceptable reduction and revision casting rate. Femur fractures are the most common orthopaedic injury for which children require a hospital admission[1] Treatment goals for these fractures include achieving fracture union while maintaining acceptable angulation and leg length, with the shortest inpatient stay and the least social and financial strain on the family[2]. If the quality of treatment of spica casting is similar in the inpatient and outpatient settings, patients should be encouraged to visit the outpatient clinic to free up available bed vacancies in the inpatients for patients who need it more
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