Skin traction combined with spica braces safe treatment option for femoral fractures in children aged 3-5 years

In children aged 3-5 years, femoral fractures are common and are frequently treated using flexible intramedullary nails (FIN) or spica casting. Recently, more surgeons have been relying on FIN surgery because of the high rate of complications associated with spica casts, such as skin irritation and re-adjustment surgery.

Menglei Wang and Yuxi Su conducted a study to evaluate the effect of skin traction combined with braces in 3–5 years old children at our hospital. The study was conducted in accordance with the Declaration of Helsinki. The study has been published in “Journal of Orthopaedic Surgery and Research.”

The authors retrospectively analyzed 125 children aged 3–5 years with femoral shaft fractures. They assigned 68 patients who underwent FIN surgery to Group A and 57 patients treated with skin traction and braces to Group B.

For patients in Group B skin traction was applied at their bedside. The fractures were observed using radiographs and adjusted according to the displacement of the fractures. The fractures were examined every 3–5 days until a bone callus appeared on the radiographs. Subsequently, the custom-made spica braces were applied and the patients were discharged from the hospital. Follow-up examinations were conducted every 1 or 2 weeks with the patients as outpatients. If the radiographs revealed that the callus was strong enough, the fracture gradually became stable, and there were more calluses at the fracture end. Subsequently, the brace was removed, and functional exercise was initiated. Normal walking and activities were gradually restored based on the healing of the fracture.

Comparative analysis included the children’s age, sex, side of the affected limb, cause of fracture, function of the knee joint, healing time of the fracture, duration of hospitalization, cost of hospitalization, and complications.

The complications evaluated included joint dysfunction, pain, infection, pressure ulcers, angular deformities, limb length differences, re-fractures, nonunion fractures, and delayed union.

Key findings of the study:

• The cost of FIN surgery was significantly higher than that of traction combined with spica braces (p < 0.001).

• No statistically significant differences were observed in sex (p=0.858), injury type (p=0.804), age (p=0.231), hospitalization time (p=0.071), bone healing time (p=0.212), and complications.

• Pressure ulcers, nonunion fractures, and delayed union did not occur in both groups.

The authors concluded that – “Both methods had similar therapeutic effects and postoperative complications in children aged 3–5 years with femoral shaft fractures. Therefore, skin traction combined with braces is recommended for this population and for patients hospitalized in institutions where several beds are available, with a consequent possibility of prolonged hospitalization.”

Level of Evidence: IV.

Further reading:

Suitability of skin traction combined with braces for treating femoral shaft fractures in 3–5 years old children Menglei Wang and Yuxi Su Journal of Orthopaedic Surgery and Research (2023) 18:63 https://doi.org/10.1186/s13018-023-03547-5