Use of a standardized functional brace may be a viable treatment alternative to spica casting in pediatric patients with diaphyseal femur fractures, according to results.
“At this point in time, I will be surprised if [bracing] does not become something that replaces body casting in terms of body casting essentially not being used except for in rare instances and [bracing] becoming the first-line treatment,” Lindsay Andras, MD, vice chief of the Jackie and Gene Autry Orthopedic Center at Children’s Hospital Lost Angeles, told Healio about the results, which received the Best Clinical Paper Research Award at the Pediatric Orthopaedic Society of North America Annual Meeting.
Bracing vs Spica Casting
Andras and colleagues randomly assigned 63 pediatric patients aged 6 months to 5 years with diaphyseal femur fractures to receive either a traditional, surgically placed spica cast (n=29) or a pre-made functional brace, which was custom fitted at the patient’s bedside by an orthotist (n=34).
“The key variable or the key outcome measure in terms of our study was can we get these fractures to heal as well with this bracing method as we can with the alternative, which is spica casting, also known as body casting,” Andras said.
Researchers defined malunion as greater than 30° varus/valgus, greater than 30° procurvatum or greater than 15-mm shortening in patients 6 months to 2 years of age and greater than 15° varus/valgus, greater than 20° procurvatum or greater than 20-mmshortening in patients 2 years to 5 years of age.
Results showed all fractures achieved union at 6 weeks after treatment. Researchers found no differences in femoral shortening or varus angulation between the two groups, although patients in the spica cast group had slightly higher mean procurvatum vs. the brace group. Researchers also noted all patients were ambulatory and participating in activities without restrictions at 1-year follow-up.
Advantages of Bracing
Andras noted one advantage of using a brace over spica casting is that the patient does not need to go to the OR for placement of the brace.
“[The brace] saves younger kids from having an anesthetic,” Andras said. “While we certainly do anesthesia on small children with regularity, it is preferrable if you can avoid it.”
She added use of a brace allowed most pediatric patients the continued use of their own car seat instead of needing a specialized car seat, which is common with use of a spica cast.
“We also found that, overall, parents and caregivers reported taking less time off of work with the brace rather than with the cast,” Andras said. “It is another indicator of ease of care and having options that are made more challenging if your child is in a body cast.”
[Source: Healio Orthopedics]