• Ezequiel H Cassinelli, Brett Young, Molly Vogt, Mary Clyde Pierce, and Vincent F X Deeney.
• Department of Orthopaedic Surgery, Case School of Medicine, Cleveland OH, USA. zekedr@hotmail.com
• J Orthop Trauma. 2005 Nov 1; 19 (10): 709-16.

ObjectivesThis study was designed to evaluate the efficacy and safety of immediate spica casting in the emergency room (ER) and evaluate the effect of discharge from the emergency room on short- term complications.DesignRetrospective review of patients treated with immediate spica casting in the ER between June 1, 1993 and July 30, 2001.SettingMajor, pediatric, orthopaedic trauma and referral center.PatientsA total of 145 pediatric femur fractures in children, younger than age 7 years, treated with immediate spica casting in the ER were reviewed to determine radiographic outcome and short-term complication rates.InterventionAll patients underwent immediate spica cast placement in the ER under conscious sedation. Patients meeting specific criteria were discharged immediately from the ER.Main Outcome MeasurementsRadiographic acceptability of alignment at fracture union (angulation, shortening), loss of reduction, number of return visits to the emergency room, and clinical outcome at final follow-up.ResultsAverage follow-up was 20 +/- 16 weeks (range, 1-9 months). Forty-eight patients (33%) were discharged from the ER. No clinical complications were noted at last follow-up. All children younger than age 2 years, and 86.5% of children ages 2 to 5 years, met acceptable malalignment parameters on final radiographs. There were 16 ER visits (11%) for cast problems. Re-reduction in the operating room was needed in 11 patients (8.9%); 6.9% of patients had a cast problem noted during follow-up visits. Only 9% of patients developed a major complication. Initial shortening was the only independent risk factor found to be associated with loss of reduction. Admission status had no significant effect on the number of ER visits or development of a complication.ConclusionsIf there are no associated factors requiring admission (ie, child abuse or polytrauma), spica casting in the ER for pediatric femur fractures followed by immediate discharge can be safely performed with a low complication rate in children younger than age 6 years, nearly eliminating the need for general anesthesia.

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