A retrospective cohort study comparing outcomes of spica casting in pediatric femoral shaft fractures by orthopedic surgeons fellowship trained in pediatrics vs. those not fellowship trained in pediatrics.

BACKGROUND

Femoral shaft fractures are common among the pediatric population and are commonly treated with spica casting depending on the patients' age. Both pediatric fellowship-trained and non-pediatric-trained orthopedic surgeons may be expected to treat these injuries while taking call. The purpose of this study is to determine differences in outcomes between casting performed by pediatric-trained orthopedic surgeons and non-pediatric-trained orthopedic surgeons.

MATERIALS AND

METHODS

A retrospective cohort study of 276 patients aged 0-5 years treated with a hip spica cast for isolated closed femoral shaft fractures was performed. The patients were subdivided based on if the treating orthopedic surgeon completed a pediatric orthopedic surgery fellowship or not. Clinical records and radiographs were reviewed. Primary outcomes included procedure length, malunion rate, and need for revision procedure. Secondary outcomes included time to weight-bearing, time in cast, and length of hospital stay, and complications.

RESULTS

There were 62 patients treated by non-pediatric-trained orthopedic surgeons and 214 by pediatric-trained surgeons. All casts were placed in the operating room under general anesthesia. Average operating room time was 37 minutes with non-pediatric-trained surgeons and 32.4 minutes by pediatric-trained surgeons (P = 0.01). The malunion rate was 39% with non-pediatric-trained surgeons and 17.5% with pediatric-trained surgeons (P = 0.0013). There was no significant difference in the length of hospital stay, cast complications, need for cast wedging, or time to weight-bearing. The study was underpowered to detect differences in revision rates.

CONCLUSION

Non-pediatric-trained surgeons were found to have a higher malunion rate and longer operative time. Despite this, spica casting remains a reliable option for both pediatric-trained and non-pediatric-trained orthopedic surgeons. Further study may be needed to assess the clinical significance of the higher malunion rate.