Functional Bracing of Femur Fractures in Young Children Avoids Anesthesia and Spica Casting with Equivalent Outcomes: A Randomized Prospective Study 2022 POSNA Annual Meeting – Best Clinical Research Paper

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Vivian Chen
Julia Skye Sanders
David L. Skaggs
Robert M. Kay
Lindsay M. Andras

Abstract

Purpose: AAOS Clinical Practice Guidelines recommend spica casting for pediatric femur fractures ages 6 months to 5 years. Kramer et al. reported the use of custom made functional braces as an alternative; however, custom making braces presented many logistical challenges. We hypothesized braces could be pre-fabricated ahead of time in multiple standardized sizes then customized to fit the patient. The purpose of this study was to compare outcomes of patients treated with prefabricated functional braces to spica casting.


Methods: A randomized prospective study was performed at two pediatric centers of patients 6 months to 5 years with diaphyseal femur fractures. Patients with polytrauma, medical comorbidities impacting fracture healing, or < 6-week follow-up were excluded. Spica casts were placed in the operating room under general anesthesia; functional braces were placed at bedside. Malunion was defined as 6 months - 2 years: > 30 o varus/valgus; >30 o procurvatum; or >15mm shortening; 2 years - 5 years: > 15 o varus/valgus; >20 o procurvatum;  or >20mm shortening.


Results: 56 patients (29 spica; 27 brace) met inclusion criteria. Mean age was 2.3 years in both groups . Injury films had similar shortening (p = 0.33), varus angulation (p = 0.09) and procurvatum (p = 0.54).


At 6-weeks post-treatment, all fractures had achieved union. There were no differences in femoral shortening (spica = 17.1mm ± 2.6, brace = 14.9mm ± 2.0, p = 0.50) or varus angulation (spica = 2.0o ± 1.8, brace = 3.6o ± 1.6, p = 0.52). The spica group had higher mean procurvatum at 22.6o ± 3.1 compared to 12.4o ± 2.2 for the brace group (p = 0.01). There were no malunions in either group. Two brace patients had fungal skin infections.


20 patients have 1-year follow-up (11 spica; 9 brace). There were no differences in femoral shortening (spica = 2.6mm ± 0.9,  brace = 3.7mm ± 2.3, p = 0.61), varus angulation (spica = 0.6o ± 2.0, brace = 1.2o ± 2.0, p = 0.83), or procurvatum (spica = 16o ± 3.43, brace = 8o ± 2.3, p = 0.06). All patients were ambulatory, except one with new ankle fracture.


Conclusion: In this prospective randomized trial, patients treated with functional bracing had equivalent outcomes to those treated with spica casting.


Significance: Standardized functional braces provide a viable treatment alternative to spica casting, avoiding cost and anesthesia associated with operating room cast placement.

Article Details

How to Cite
Vivian Chen, Julia Skye Sanders, David L. Skaggs, Robert M. Kay, & Lindsay M. Andras. (2022). Functional Bracing of Femur Fractures in Young Children Avoids Anesthesia and Spica Casting with Equivalent Outcomes: A Randomized Prospective Study: 2022 POSNA Annual Meeting – Best Clinical Research Paper. Journal of the Pediatric Orthopaedic Society of North America, 4(3). https://doi.org/10.55275/JPOSNA-2022-0076
Section
POSNA 2023 Annual Meeting Highlights