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• W2332494202 abstract "Commentary Despite the recent trend for surgical stabilization of diaphyseal femoral fractures, hip spica casting is still an appropriate treatment option for children aged six months to five years1. When certain fracture criteria are met, early hip spica casting has a good track record of results, with acceptable leg length equality, healing time, and motion2-4. Also, the overall medical cost of hip spica casting, including the cost of supplies and overall hospitalization time, is significantly less than that of other treatment options5. However, although patients return home quickly, it is not to their baseline home lifestyle. Hip spica casting transfers the physical and financial burden of care to the family and community. Caring for a child in a hip spica cast, specifically a double-leg cast, is extremely challenging. Unfortunately, as medical professionals, we do not witness the burden placed on the family at home and at school. As a result, these aspects can be overlooked. Transportation, daily supervision, hygiene, and patient tolerance of the cast are all issues faced by the family. Hughes et al. found that mobility of the patient with a double-leg hip spica was the most difficult aspect experienced by the family5. They also found that parents with older children had more issues with the hip spica cast compared with parents of younger children, mainly because the older children were heavier, were more difficult to carry, and had a slower healing rate. Older children also had been walking independently for more time prior to the injury, which made the transition to non-weight-bearing much more difficult. Safe vehicle travel is a major issue for families. Specialized car seats are required to transport children with a double-leg spica cast as their typical car seat is too small to accommodate them. Some parents cannot afford the purchase of another car seat, and as a result may forgo a car seat altogether when transporting the child. This puts the child’s safety at risk during transportation. More recently, some hospitals have set up car seat loaner programs to deal with this issue. However, the financial burden for this is placed solely on the hospital. This may be difficult for smaller community-based hospitals given the current state of the economy and health care. In some instances, these car seats are never returned and the hospital sustains a resultant monetary loss and cannot afford to buy replacements. This takes resources away from future families in need, and places us back at square one. In these economic times, it may be difficult for working parents to care for a child in a hip spica. Although Hughes et al. did find that families with younger children had more preexisting care arrangements for them, they still found that, on average, families with two working parents required three weeks off from work to care for the patient5. In single-parent homes, this burden can be even greater and cause a stressful home environment. What is so important about the study by Leu et al. is that it may help us to address some of these socioeconomic problems encountered with hip spica casting. Its results showed that use of a single-leg hip spica cast was associated with fewer parental missed workdays, better fit in a standard car seat, and overall better patient comfort when sitting in a chair. The authors also found that the single-leg-cast group exhibited a trend toward being able to walk in the cast. The study provided Level-I evidence that there is no difference between single and double-leg hip spica casting with regard to healing of diaphyseal femoral fractures in patients without an underlying bone or neuromuscular disorder. In conclusion, the study reinforced the validity of hip spica casting as an acceptable treatment option for patients two to six years old who have a diaphyseal femoral fracture with <2.5 cm of shortening. However, most importantly, it showed that the healing results following single-leg hip spica casting are similar to those with double-leg casting, but with much less morbidity to the patient and family." @default.
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• W2332494202 date "2012-07-18" @default.
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• W2332494202 title "Socioeconomic Implications of Spica Casting" @default.
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• W2332494202 doi "https://doi.org/10.2106/jbjs.l.00500" @default.
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