Functional Outcome in Primary Hip Spica In Children Under 5 Years

  • Usama Bin Saeed, Dr. Senior Registrar, Orthopedics, Allied Hospital, Faisalabad-Pakistan
Keywords: Femoral shaft fractures, Children, Primary Spica cast, Shortening,, Malunion


Introduction: Fractures shaft of femur in kids are common disorders faced by all orthopedic surgeons in their day to day observe. These fractures
account for 7.6% of all pediatric fractures. Such fractures typically result from direct violence in most of the cases. Low energy traumas like fall from
little heights or sports connected injuries in younger kids and high energy trauma like road traffic accidents in older kids are the common modes of
injury in such fractures. About the management of those fractures below five years a wide variety of opinions exist. However, opinion still differs for
kids between five to eleven years. Objective: To determine the outcome of primary Spica cast (immediate within 24 hours) in femoral shaft fractures
in children in terms of frequency of shortening and malunion. Study design: Descriptive case series study. Settings: Orthopedic Department of Allied
and DHQ hospital Faisalabad. Duration: 01-07-2014 to 30-06-2017. Methodology: After approval of study from hospital ethical review committee,
informed consent was taken from the parents or guardians of children. All children with fracture of femur with age group 6 months to 10 years were
admitted through emergency department of the hospital. After initial treatment following ATLS protocol, x-rays were taken from radiology department
of the hospital. Patients were treated with primary Spica cast. After application of Spica cast patient was called after 6 weeks and assessed for any
shortening or malunion at 6 weeks. Malunion was labeled if angulation on anteroposterior x-ray was more than 10 degree and on lateral x-ray was
more than 30 degree and shortening of more than 2.5cm. All the information was recorded on proforma. Results: In this study, out of a total of 156
cases, 54.49%(n=85) were between 0.6 to 5 years and 45.51%(n=71) were between 6-10 years, mean±sd was calculated as 5.68+2.81 years,
58.97%(n=92) were male and 41.03%(n=64) were females. Frequency of shortening of length was recorded in 7.69%(n=12) while 92.31%(n=144) had
no findings of the shortening. Frequency of malunion was recorded in 5.12%(n=8) while 94.88%(n=148) had no findings of the malunion. Conclusion:
We concluded that the outcome of primary Spica cast (immediate within 24 hours) in femoral shaft fractures in children in terms of frequency of
shortening and malunion is good and satisfactory with low frequency of these complications, it can be used in population as an effective method.