A retrospective cohort study comparing outcomes of spica casting in pediatric femoral shaft fractures by orthopedic surgeons fellowship trained in pediatrics vs. Those not fellowship trained in pediatrics

Background: Femoral shaft fractures are common amongst the pediatric population and are commonly treated with spica casting depending on the patients’ age. Both pediatric fellowship trained and non-pediatric trained orthopedic surgeons may be expected to treat these injuries while taking call. The purpose of this study is to determine differences in outcomes between casting performed by pediatric-trained orthopedic surgeons and non-pediatric trained orthopedic surgeons. Materials and Methods: A retrospective cohort study of 276 patients age 0-5 years treated with a hip spica cast for isolated closed femoral shaft fractures was performed. The patients were subdivided based on if the treating orthopedic surgeon completed a pediatric orthopedic surgery fellowship or not. Clinical records and radiographs were reviewed. Primary outcomes included procedure length, malunion rate, and need for revision procedure. Secondary outcomes included time to weightbearing, time in cast, and length of hospital stay, and complications. Results: There were 62 patients treated by non-pediatric trained orthopedic surgeons and 214 by pediatric trained surgeons. All casts were placed in the operating room under general anesthesia. Average operating room time was 37 minutes with non-pediatric trained surgeons and 32.4 minutes by pediatric trained surgeons (p = .01). The malunion rate was 39% with non-pediatric trained surgeons and 17.5% with pediatric trained surgeons (p = .0013). There was no significant difference in the length of hospital stay, cast complications, need for cast wedging, or time to weightbearing. The study was underpowered to detect differences in revision rates Conclusion: Non-pediatric trained surgeons were found to have a higher malunion rate and longer operative time. Despite this, spica casting remains a reliable option for both pediatric trained and non-pediatric trained orthopedic surgeons. Further study may be needed to assess the clinical significance of the higher malunion rate. Level of Evidence: Level III, retrospective cohort study