Single-Leg Casts Sufficient to Heal for Youngest Hip and Thigh Fracture Patients

Age-old practice of casting both legs in kids with hip and thigh fractures is being contested by study demonstrating that such fractures heal just as well in single-leg casts.

Age-old practice of casting both legs in kids with hip and thigh fractures is being contested by a new Johns Hopkins Children’s Center study which demonstrates that such fractures heal just as well in single-leg casts, even as children get better comfort and mobility.

The findings of the study, which involved 52 Johns Hopkins patients ages 2 through 6, are published online June 13 in The Journal of Bone & Joint Surgery.

Fracture - Types - Causes - Symptoms - Diagnosis - Treatment - FAQs
A fracture is a condition where the continuity of the bone is lost. Majority of bone fractures occur because of high force impact or stress on a bone.

Casting both legs and hips has long been thought the only way to assure proper healing and pelvic immobilization in young children who wiggle around and are in perpetual motion, the researchers noted.

Not so, the new Hopkins study shows.

"The single-leg approach not only appears to be just as effective and safe as double-leg casting in terms of healing, but also it makes the child''s life much easier and requires less complicated daily care," says senior investigator Paul Sponseller, M.D. M.B.A, director of pediatric orthopedics at Johns Hopkins Children''s Center.

Fracture of Knee Cap - Causes - Symptoms - Diagnosis - Treatment - FAQs
Patella fracture is a kneecap injury that needs surgical correction. Undisplaced fracture can be healed by using a brace to keep the knee immobile.

Surgical repair is the treatment of choice for hip and thigh fractures in older children, but those younger than 6 years of age do better with casting only, the investigators say. The American Academy of Orthopaedic Surgeons recently recommended casting as the first line of treatment for children younger than 5 to avoid general anesthesia and surgical complications.

The cast works by immobilizing the hips and thighs so that bones or tendons can heal properly, but it can also be cumbersome and uncomfortable. Casting can restrict motion and cause skin problems, aches and pains, increased muscle pressure and reduced blood flow to nerves and tissue. Casting also requires more complex daily maintenance by parents and other caregivers.

Colles Fracture / Broken Wrist
Colles fracture or broken wrist is a wrist fracture, which occurs within an inch of the wrist joint. Colles fracture involves the forearm bone’s distal end of the radius.

In the new study, 28 of the 52 children seen at Hopkins were randomly assigned to get double leg casts, while the remainder got single leg casts. The researchers used bi-weekly X-rays to monitor bone healing and questionnaires to gauge parental ease of care and the child''s comfort and physical functioning.

While children in both groups healed equally well without any major complications, those in single-leg casts reported greater comfort and mobility, fit more easily in car seats, got dressed more easily and sat more comfortably in chairs, the study showed. Also, the parents and caregivers of children in single-leg casts reported taking less time off from work to provide care. They had, on average, eight fewer days missed from work, the researchers say.

Screening for Osteoporosis
The risk of suffering from osteoporotic fractures is 30-50% in women and 15 to 30% in men. Osteoporosis screening is currently recommended for women only.

Other investigators on the study included Dirk Leu, M.D., M. Catherine Sargent, M.D., Michael Ain, M.D., Arabella Leet, M.D., and John Tis, M.D.
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Source-Newswise