Purpose: The aim of this study was to evaluate the clinical and radiological results and hospital stay of incorporated hip spica cast treatment in peadiatric diaphyseal femoral fractures.

Material and methods: 49 femoral diaphyseal fractures of 48 children who were admitted to our institution between March 1998 and November 2001 were included in this study. Mean age was 4.5 years. Mean follow up was 30.5 months.The mechanisms of the fractures were: 45.7% road traffic accident, 8.3% falling and 6.2% sports injuries. Immediate supracondylar skeletal traction with a 3 mm. K-wire was applied to all patients under general anesthesia. This wire was incorporated with a hip spica cast after the reduction of the fracture under fluoroscopic control. All patients discharged from the clinic after 24 hours. Reduction and evidence of callus formation have been carefully checked with two plane X-rays taken on the follow-ups. We have removed the cast and K-wire in the evidence of callus formation on both AP and lateral X-ray views. After two weeks of careful rehabilitation program the patients were encouraged to walk with full weight bearing. The patients were followed in every three months in the first year and in every six months in the second year. Radiological assessment of roentgenograms and scoring of the final radiological result after fracture consolidation were evaulated as shown in Table 1.

Findings: The average hospital stay was 24 hours. We have noticed pin tract infection only in 2 cases. We had only one re-fracture. Mean duration of cast removal was 6.9 weeks and mean consolidation time of the fracture was 13.3 weeks. On the final follow-up X-rays, mean overriding was 6mm(range 0–20 mm.). Mean shortening of the affected limb was 2mm. The mean deformity noted at the cast removal was as follows: Varus angulation 3.8 degrees, Valgus angulation 5.6 degrees, Anterior angulation 13.3 degrees. At the final examination we have noted the mean deformity angles as follows: Varus angulation 1.7 degrees, Valgus angulation 3.6 degrees, Anterior angulation 2.27 degrees. We have evaluated the results as excellent in 35 cases(72%), good in 9 cases(19%), moderate in 4 cases(9%)

Conclusion: The treatment of femur fractures in children is controversial and highly variable. Each method of treatment has practical and theoretical advantages and disadvantages. The literature provides few comparative studies. Malunion is the most frequently used endpoint of treatment but every treatment is prone to different types of malunion. Any evaluation of treatment must consider all aspects of malunion including displacement, angulation, rotation, and length. Our study suggests that the clinical results of immediate incorporated hip spica cast application is a very reliable method compared with other choice of treatments. Safe and easy application, short hospital stay and low cost, are the major advantages of this method.