Prefabricated Functional Bracing Versus Spica for Pediatric Femur Fractures Reduces Cost.

BACKGROUND

Hip spica casting under general anesthesia is standard treatment for femoral shaft fractures in children aged 6 months to 5 years. Prefabricated functional braces (PFBs) can be applied in the emergency department without general anesthesia. We compared hospital utilization, charges, reimbursement, and short-term outcomes between treatments.

METHODS

We reviewed children aged 6 months to 5 years with isolated unilateral femoral shaft fractures treated at a single level I trauma center. Spica patients were identified retrospectively (2021 to 2024; n=38), and PFB patients were identified (2024 to 2025; n=22). We compared length of stay (LOS), hospital-based (HB) and professional-based (PB) charges, reimbursement proportion, sedation requirements, and complications. Insurance was categorized as public versus private, and reimbursement was analyzed overall and within insurance strata.

RESULTS

PFB treatment reduced LOS (16.4±8.2 vs. 26.2±15.9 h, P=0.003) and total charges ($56,372±$15,212 vs. $78,892±$14,780, P<0.001), a mean reduction of $22,520 per patient (~$20,000 net after device cost). Public insurance was more common in the spica group (71% vs. 41%, P=0.030). Overall reimbursement proportion was higher for PFB (47.8%±37.4% vs. 26.2%±30.2%, P=0.027); however, within insurance strata, reimbursement did not differ significantly by treatment, suggesting the unadjusted difference was attributable to payer mix. No brace patient required general anesthesia; 77% required no sedation. Total charges did not differ by sedation status within the brace group ($55,594 vs. $55,640). Complication rates were similar (27% vs. 37%, P=0.57).

CONCLUSIONS

In appropriately selected young children with femoral shaft fractures, PFB management avoids general anesthesia, shortens LOS, and substantially reduces charges while maintaining comparable short-term clinical outcomes.

LEVELS OF EVIDENCE: Level III-therapeutic.