• Rhett MacNeille, Allison Gockley, and William Hennrikus.
• From the Department of Orthopaedics, Penn State Milton S. Hershey Medical Center, Hershey, PA.
• Pediatr Emerg Care. 2021 May 1; 37 (5): e252e254e252-e254.

ObjectiveThe objective of the current study was to analyze the outcomes of short versus long leg casts in the treatment of childhood accidental spiral tibial (CAST) fractures.MethodsA retrospective review was performed of medical records at a single tertiary children's hospital from 2009 to 2014 of children with distal, spiral tibial fractures (CAST fractures). The following points were documented for each patient: sex, laterality of fracture, age at presentation, type of cast, length of time in cast, use of a controlled ankle motion boot after cast removal, suspicion for abuse, and complications including skin irritation, skin breakdown, infection, compartment syndrome, fracture displacement, and gait disturbances.ResultsA total of 21 patients with an age range of 12 to 62 months were found to have CAST fractures as confirmed by x-ray. Fourteen were treated with short leg casts, whereas 7 were treated with long leg casts. Both groups healed with equal outcomes, and there was no documented suspicion for abuse in any case.ConclusionsA short leg walking cast seems to be an effective and safe method of treatment for CAST fractures and could be considered as potentially preferable to long leg casts because of the added benefits of increased mobility and function. Follow-up to this preliminary study is warranted to better elucidate any differences in benefit between these treatment options, and clinical judgment should be used when considering immobilization options.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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