Spica Cast Treatment Research Articles

Tibial cast wedging: a simple and effective technique

THE JOURNAL OF BONE AND JOINT SURGERY Frohlich-type body and anatomical variations such as excess retroversion. In contrast, bilateral cases are most common during treatment for hypothalamo-pituitary axis failure, during which hormone replacement can result in a rapid gain in height and weight. Another cause is hyperparathyroidism, either primary or secondary to chronic renal failure. ‘In-situ’ pinning has been used for a mild or moderate slip but in this young age group complications such as growth arrest are numerous. Leg-length discrepancy is often less than should theoretically occur; in some cases the contralateral physis also undergoes premature fusion, as a result of the underlying constitutional disorder or from asymptomatic slip. Chondrolysis is another possible complication of nailing, and avascular necrosis may follow any type of manipulative reduction. Severe slips have a poorer long-term prognosis for arthritic degeneration but the theoretical advantages of improving the biomechanics are outweighed by the complications of osteotomy in this young age group. Spica-cast treatment has not been associated with chondrolysis in this age group, and has been shown to stabilise the slip and leave excellent potential for remodelling (Clarke and Harrison 1986).

Improved Treatment of Femoral Shaft Fractures in Children

In the past 15 to 20 years, little improvement has been made in the standard treatment of femur fractures in children. Children younger than two years of age or weighing less than 30 pounds are normally treated with skin traction or immobilized in a plaster cast or both. Older or heavier children are often treated with skeletal traction, followed by early or late application of spica cast in the neutral position. A method of spica cast treatment that immobilizes the limb in the 90-90 position using a reinforced cast incorporating a distal femoral traction pin--the pontoon spica--allows for early cast application and discharge from the hospital and encourages early motion of the knee joint. A series of 23 femur fractures in 21 patients were treated with this method. This series is compared with a series of 38 fractures treated with conventional methods. The follow-up period ranged from three to 24 months. The pontoon method provided better results in control of alignment than the conventional method, with no greater discrepancy in leg lengths than generally observed after skin traction and hip spica casts. The average hospital cost reduction was 73%, or approximately $13,334. There were no major complications with the pontoon method, which is now a standard treatment for femoral fractures in children.

Ipsilateral Fracture of the Femur and Tibia Treated in a Quadrilateral Cast Brace

In 15 patients traction followed by cast brace was an acceptable method of treatment for ipsilateral fractures of the tibia and femur. Prolonged healing times and limited range of motion of the knee were not significant problems. This method of treatment is especially indicated in patients with severe open injuries or comminution of femoral shaft fractures which do not safely lend themselves to rigid internal fixation. The hospitalization time, 5 weeks, is considerably less than for spica cast treatment of femoral shaft fractures and is comparable to that reported for open reduction and rigid fixation of femoral shaft fractures.