Paediatric femoral fractures : impact of immediate and delayed casting on length of hospitalisation

Abstract

Current practice guidelines suggest a period of skin traction prior to spica casting, yet immediate spica casting appears to have the shortest hospitalisation time. The following PICO question arose: in children with femoral fractures, does a period of skin traction followed by spica cast affect the length of hospitalisation when compared to immediate casting? The elements of this question define the population as children aged two to ten years who are admitted with a stable fracture of the femoral shaft as confirmed by radiology, with the intervention of an immediate spica cast compared to the Thomas splint or Gallows traction followed by spica cast and their effect on the outcome or length of hospitalisation. Studies comparing the two interventions and studies that give results of the effectiveness and safety of immediate spica casting in terms of patient outcomes were included. Length of hospital stay as a primary or secondary outcome were also included. Paediatric femoral fractures of the shaft of different types were included to ensure a more in-depth comparison of current treatments. The Critical Appraising Skills Programme (CASP) and Coughlin, Cronin, and Ryan’s tool for quantitative research were used as critical appraisal tools. The findings indicate that while there is not enough high quality evidence to support a change in protocols at this time, there is some evidence of quality to show that immediate spica casting results in comparable clinical outcomes and shorter hospitalisation. Finally, findings indicate that one area which affects length of hospitalisation for these children and where improvement is recommended, is parental education and support. Findings support that parental lack of knowledge may contribute to longer hospitalisation, and this is where this study currently recommends a change in practice to provide improved support and education for parents of children with this injury.