Use of immediate hip spica in the emergency room and out patient clinic in treating closed femoral fractures in children

Abstract

Twenty children with closed diaphyseal fracture femur were included in a prospective study at emergency department of Al- Samawa and Al-Rhumaitha hospitals from February 2009 to October 2010.There were 15 boys (75%) and 5 girls (25%) . Their age ranged from 10 months to 6 years. Left femur was fractured in 13 (65%) and the right one in the remaining 7 (35%). Oblique fractures were the most frequently reported 12 (60%),followed by spiral fractures in 6 (30%), and transverse fractures in the remaining two (10%). The mechanism of injury was fall at play in 10 patients (50%), road traffic accident (RTA) in 8 (40%) ,and bicycle accidents in the remaining 2 (10%) . Associated soft tissue injuries to other parts of the body had occurred in 4 (20%), all of these were of minor degrees and were treated conservatively. The inclusion criteria used in this study were a patient with a 6 years or less of age with traumatic closed, uncomplicated diaphysal fracture of femur. All cases were treated by immediate hip spica casting under the sedative effect of intravenous diazepam in the emergency room (ER) and outpatient clinic depending on simple, available facilities without using general anesthesia nor C-arm. The duration of the spica was less than or 45 days in 14 patients, more than 45 days in 6 patients. Bony union was achieved in about 3 to 10 weeks (median 6) . There were no instances of malunion, nonunion, or rotational deformities. At final follow-up, limb length discrepancy was noted in 5 children (25%) .Shortening of the fractured limb was 0.5cm in 2 patients, 1cm in 2, and 1.5cm in 1, but none had a discrepancy of greater than 1.5cm or a ‘short-legged’ gait. Mild degree of temporary knee joint stiffness was noted in all patients immediately following spica removal which had responded fully to a short course of home exercises programs. The study concluded that immediate hip spica casting in the emergency room without prolonged traction in hospital and without the need of general anesthesia with its known adverse complications is a simple ,feasible and cheap method in treating uncomplicated femoral shaft fractures in children in the first six years of age.