Single-Leg Spica Cast Application for Treatment of Pediatric Femoral Fracture

JBJS Essential Surgical Techniques
M Catherine Sargent

Abstract

Use of a single-leg spica cast for femoral fractures in ambulatory children 1 to 5 years of age facilitates care and mobilization of the patient. It may allow a shorter duration of cast treatment than is possible with a traditional one and one-half-leg spica cast, particularly in patients 1 to 3 years of age. The single-leg spica is indicated for children who are small enough to be lifted safely in the cast and who have an isolated, closed, low-energy femoral shaft fracture. The procedure consists of the following steps:Step 1: Obtain adequate sedation. General anesthesia should be used in the operating room, whereas conscious sedation may be used in the emergency or procedure room setting. The location of the procedure should be determined by available resources.Step 2: Determine the position of optimal alignment by visual examination of the thigh and leg. If intraoperative imaging is available, assess fracture stability by performing the telescope test described by Thompson et al.1-i.e., by gently applying axial load to the thigh to assess for shortening under fluoroscopic monitoring. Shortening of >3 cm reflects substantial periosteal stripping and is associated with an increased risk of loss of reduction in the cast. Altern...Continue Reading

References

Jul 1, 1995·Journal of Pediatric Orthopedics·B F HughesJ D Thompson
May 1, 1997·Clinical Orthopaedics and Related Research·J D ThompsonP P Griffin
Jul 14, 1998·Journal of Pediatric Orthopedics·R IllgenJ R Kasser
Dec 1, 2004·The Journal of Bone and Joint Surgery. British Volume·S Bridgman, R Wilson
Aug 26, 2006·Journal of Pediatric Orthopedics·Scott J MubarakKenneth J Noonan
Jun 15, 2012·The Journal of Bone and Joint Surgery. American Volume·Dirk LeuPaul D Sponseller

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